Miscarriage
Classification and external resources
A complete spontaneous abortion at about six weeks from conception, i.e. eight weeks from the last menstrual period (LMP)
ICD-10	O03
ICD-9	634
MedlinePlus	001488
eMedicine	topic list
MeSH	D000022

Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation. Miscarriage is the most common complication of early pregnancy.^[1][2] Spontaneous abortion is a frequently used clarification to distinguish this natural process from an induced abortion.

Terminology[link]

Very early spontaneous abortions—those that occur before the sixth week LMP (since the woman's last menstrual period)—sometimes are termed early pregnancy loss^[3] or chemical pregnancy.^[4] Those that occur after the sixth week post-LMP are medically termed clinical spontaneous abortion.^[3]

In medical (and veterinary) contexts, the technical term "abortion" refers to any process by which a pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or intentionally induced. Many women who have had miscarriages, however, object to the term "abortion" in connection with their experience, because in everyday English the word may be strongly associated with induced abortions. In recent years there has been discussion in the medical community about avoiding the use of this term in favor of the term, "miscarriage".^[5] In 2005 the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate a revision of nomenclature used to describe early pregnancy events.^[6]

Labour resulting in live birth before the 37th week of pregnancy is termed "premature birth", even if the infant dies shortly afterward. The limit of viability at which 50% of fetuses survive longterm is around 24 weeks, with moderate or major neurological disability dropping to 50% only by 26 weeks.^[7] Although long-term survival has never been reported for infants born from pregnancy shorter than 21 weeks and 5 days,^[8] fetuses born as early as the 16th week of pregnancy may sometimes live for some minutes after birth.^[9]

A fetus that dies while in the uterus after about the 20–24th week of pregnancy may be termed, a "stillbirth"; the precise gestational age definition varies by country. Premature births or stillbirths are not generally considered "miscarriages", though usage of the terms and causes of these events may overlap. Another term for this has been coined, intrauterine fetal demise (IUFD).^{[by whom?]}

Classification[link]

The clinical presentation of a threatened abortion describes any bleeding seen during pregnancy prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems.

Alternatively the following terms are used to describe pregnancies that do not continue:

• An empty sac is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. Other terms for this condition are blighted ovum and anembryonic pregnancy.
• An inevitable abortion describes a condition in which the cervix has already dilated open,^[10] but the fetus has yet to be expelled. This usually will progress to a complete abortion. The fetal heart beat may have been shown to have stopped, but this is not part of the criteria.
• A complete abortion is when all products of conception have been expelled. Products of conception may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane.
• An incomplete abortion occurs when tissue has been passed, but some remains in utero.^[11]
• A missed abortion is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed or missed miscarriage.

The following two terms consider wider complications or implications of a miscarriage:

• A septic abortion occurs when the tissue from a missed or incomplete abortion becomes infected. The infection of the uterus carries risk of spreading infection (septicaemia) and is a grave risk to the life of the woman.
• Recurrent pregnancy loss (RPL) or recurrent miscarriage (medically termed habitual abortion) is the occurrence of three consecutive miscarriages. If the proportion of pregnancies ending in miscarriage is 15%,^[12] then the probability of two consecutive miscarriages is 2.25% and the probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy loss is 1%.^[12] A large majority (85%) of women who have had two miscarriages will conceive and carry normally afterward.

The physical symptoms of a spontaneous abortion vary according to the length of pregnancy:^[13]

• At up to six weeks only small blood clots may be present, possibly accompanied by mild cramping or period pain.
• At 6 to 13 weeks a clot will form around the embryo or fetus, and the placenta, with many clots up to 5 cm in size being expelled prior to completion of the process. The process may take a few hours or be on and off for a few days. Symptoms vary widely and may include vomiting and loose bowels, possibly due to physical discomfort.
• At more than 13 weeks the fetus may be passed easily from the uterus, however the placenta is more likely to be fully or partially retained in the uterus, resulting in an incomplete abortion. The physical signs of bleeding, cramping, and pain may be similar to an early stage abortion, but sometimes more severe and labour-like.

Signs and symptoms[link]

The most common symptom of a spontaneous abortion is bleeding;^[14] bleeding during pregnancy may be referred to as a threatened abortion. Of women who seek clinical treatment for bleeding during pregnancy, about half will abort.^[15] Symptoms other than bleeding are not statistically related.^[14]

Spontaneous abortion may be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing. Women pregnant from ART methods, and women with a history of aborting, may be monitored closely and so detection is sooner than women without such monitoring.

Several medical options exist for managing documented nonviable pregnancies that have not been expelled naturally.

Psychological[link]

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2011)

Although a woman physically recovers from a spontaneous abortion quickly, in general, psychological recovery for parents may take a long time. People differ greatly in this regard: some are able to move on after a few months, but others take more than a year. Still others may feel relief or other less negative emotions. A questionnaire (GHQ-12 General Health Questionnaire) study following women having aborted showed that half (55%) of them presented with significant psychological distress immediately, 25% at 3 months; 18% at 6 months, and 11% at 1 year after miscarriage.^[16]

A cemetery for miscarried embryos and fetuses

Besides the feeling of loss, a lack of understanding by others is often important. People who have not experienced it themselves may find it difficult to empathize with what has occurred, and how upsetting it may be. This may lead to unrealistic expectations of the parents' recovery. The pregnancy and the abortion cease to be mentioned in conversations, often because the subject is too painful. This may make the woman feel particularly isolated. Inappropriate or insensitive responses from the medical professionals can add to the distress and trauma experienced, so in some cases attempts have been made to draw up a standard code of practice.^[17]

Often interaction with pregnant women and newborn children is painful for parents who have experienced spontaneous abortion. Sometimes this makes interaction with friends, acquaintances, and family very difficult.^[18]

Causes[link]

Abortions may occur for many reasons, not all of which can be identified. Some of these causes include genetic, uterine, or hormonal abnormalities, reproductive tract infections, and tissue rejection.

First trimester[link]

Most clinically apparent spontaneous abortions (two thirds to three-quarters in various studies) occur during the first trimester.^[19][20]

Chromosomal abnormalities are found in more than half of embryos aborted in the first 13 weeks. An embryo with a genetic problem has a 95% probability of being aborted. Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to recur. Chromosomal problems due to a parent's genes are, however, a possibility. This is more likely to have been the cause in the case of a woman suffering repeated spontaneous abortions, or if one of the parents has a child or other relatives with birth defects.^[21] Genetic problems are more likely to occur with older parents; this may account for the higher rates observed in older women.^[22]

Progesterone deficiency may be another cause. Women diagnosed with low progesterone levels in the second half of their menstrual cycle (luteal phase) may be prescribed progesterone supplements, to be taken for the first trimester of pregnancy.^[21] No study has shown that general first-trimester progesterone supplements reduce the risk however, (when a mother might already be losing her baby),^[23] and even the identification of problems with the luteal phase as a contributing factor has been questioned.^[24]

Second trimester[link]

Up to 15% of pregnancy losses in the second trimester may be due to uterine malformation, growths in the uterus (fibroids), or cervical problems.^[21] These conditions also may contribute to premature birth.^[19]

One study found that 19% of second trimester losses were caused by problems with the umbilical cord. Problems with the placenta also may account for a significant number of later-term miscarriages.^[25]

Risk factors[link]

Pregnancies involving more than one fetus are considered at increased risk.^[21]

Uncontrolled diabetes greatly increases the risk also. Because diabetes may develop during pregnancy (gestational diabetes), an important part of prenatal care is to monitor for signs of the disease.^[21]

Polycystic ovary syndrome is a risk factor, with 30–50% of pregnancies in women with PCOS being aborted during the first trimester. Two studies have shown treatment with the drug metformin significantly lowers the rate of abortion in women with PCOS (the metformin-treated groups experienced approximately one-third the miscarriage rates of the control groups).^[26] A 2006 review of metformin treatment in pregnancy found insufficient evidence of safety, however, and did not recommend routine treatment with the drug.^[27]

High blood pressure during pregnancy, known as preeclampsia, is sometimes caused by an inappropriate immune reaction (paternal tolerance) to the developing fetus, and is associated with the risk of spontaneous abortion. Similarly, women with a history of recurrent spontaneous abortions are at risk of developing preeclampsia.^[28]

Severe cases of hypothyroidism increase the risk of miscarriage. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. The presence of certain immune conditions such as autoimmune diseases is associated with a greatly increased risk.^[21] The presence of anti-thyroid autoantibodies is associated with an increased risk with an odds ratio of 3.73 and 95% confidence interval 1.8–7.6.^[29]

Certain illnesses (such as rubella, chlamydia and others) increase the risk.^[21]

Tobacco (cigarette) smokers have an increased risk of spontaneous abortion.^[30] An increase in the rates also is associated with the father being a cigarette smoker.^[3] The husband study observed a 4% increased risk for husbands who smoke fewer than 20 cigarettes/day, and an 81% increased risk for husbands who smoke 20 or more cigarettes/day.

Cocaine use increases the rates.^[30] Physical trauma, exposure to environmental toxins, and use of an IUD during the time of conception have also been linked to increased risk.^[31]

Antidepressants specially paroxetine and venlafaxine can lead to spontaneous abortion.^[32][33]

The age of the mother is a significant risk factor. Spontaneous abortion rates increase steadily with age, with more substantial increases after age 35.^[34][35]

Several other factors have been correlated with higher rates in some research, but whether they cause the abortions is debated. No causal mechanism may be known, the studies showing a correlation may have been retrospective (beginning the study after the abortions occurred, which may introduce bias) rather than prospective (beginning the study before the women became pregnant), or both. A greater correlation has been shown in the following categories, however.

Autoimmune disease[link]

Some research suggests autoimmunity as a possible cause of recurrent or late-term abortions.^[36] Autoimmune disease occurs when the body's own immune system acts against itself. Therefore, in the case of an autoimmune-induced abortions the woman's body attacks the growing fetus or prevents normal pregnancy progression.^[37][38] Further research also has suggested that autoimmune disease may cause genetic abnormalities in embryos which in turn may lead to spontaneous abortion.^[39]

Morning sickness[link]

Nausea and vomiting of pregnancy (NVP, or morning sickness) are associated with a decreased risk. Several mechanisms have been proposed for this relationship, but none are widely agreed upon.^[40] Because NVP may alter a woman's food intake and other activities during pregnancy, it may be a confounding factor when investigating possible causes of spontaneous abortion.

Exercise[link]

Another factor is exercise. A study of more than 92,000 pregnant women found that most types of exercise (with the exception of swimming) correlated with a higher risk of aborting prior to 18 weeks. Increasing time spent on exercise was associated with a greater risk: an approximately 10% increased risk was seen with up to 1.5 hours per week of exercise, and a 200% increased risk was seen with more than 7 hours per week of exercise. High-impact exercise was especially associated with the increased risk. No relationship was found between exercise rates after the 18th week of pregnancy. The majority of abortions had already occurred at the time women were recruited for the study, and no information on nausea during pregnancy or exercise habits prior to pregnancy was collected.^[41]

Caffeine[link]

Caffeine consumption also has been correlated to spontaneous abortion rates, at least at higher levels of intake. A 2007 study of more than 1,000 pregnant women found that those who reported consuming 200 mg or more of caffeine per day experienced a 25% rate, compared to 13% among women who reported no caffeine consumption. 200 mg of caffeine is present in 10 oz (300 mL) of coffee or 25 oz (740 mL) of tea. This study controlled for pregnancy-associated nausea and vomiting (NVP or morning sickness): the increased rate for heavy caffeine users was seen regardless of how NVP affected the women. About half of the abortions had already occurred at the time women were recruited for the study.^[42] A second 2007 study of approximately 2,400 pregnant women found that caffeine intake up to 200 mg per day was not associated with increased rates (the study did not include women who drank more than 200 mg per day past early pregnancy).^[43] A prospective cohort study in 2009 showed no increased risk.^[44]

Diagnosis[link]

A spontaneous abortion may be confirmed via ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. Genetic tests also may be performed to look for abnormal chromosome arrangements.

Management[link]

Bleeding during early pregnancy is the most common symptom of both impending abortion and of ectopic pregnancy. Pain does not strongly correlate with the former, but is a common symptom of ectopic pregnancy.^[14] Typically, in the case of blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, serial βHCG tests should be performed to rule out ectopic pregnancy, which is a life-threatening situation.^[45][46]

If the bleeding is light, making an appointment to see one's doctor is recommended. If bleeding is heavy, there is considerable pain, or there is a fever, then seeking emergency medical attention is recommended.

Whilst bed rest has been advocated in the past to help ensure that a threatened pregnancy might continue, and in one study possibly helped when small subchorionic hematoma had been found on ultrasound scans,^[47] the prevailing opinion is that this is of no proven benefit.^[48]

No treatment is necessary for a diagnosis of complete abortion (so long as ectopic pregnancy is ruled out). In cases of an incomplete abortion, empty sac, or missed abortion there are three treatment options:

• With no treatment (watchful waiting), most of these cases (65–80%) will pass naturally within two to six weeks.^[49] This path avoids the side effects and complications possible from medications and surgery,^[50] but increases the risk of of mild bleeding, need for unplanned surgical treatment, and incomplete abortion.^[49]
• Medical management usually consists of using misoprostol (a prostaglandin, brand name Cytotec) to encourage completion of the natural process. About 95% of cases treated with misoprostol will complete within a few days.^[49]
• Surgical treatment (most commonly vacuum aspiration, sometimes referred to as a D&C or D&E) is the fastest way to complete the process. It also shortens the duration and heaviness of bleeding, and avoids the physical pain associated with the abortion.^[49] In cases of repeated spontaneous abortions, D&C is also the most convenient way to obtain tissue samples for karyotype analysis (cytogenetic or molecular), although it is also possible to do with expectant and medical management. D&C, however, has a higher risk of complications, including risk of injury to the cervix (e.g. cervical incompetence) and uterus, perforation of the uterus, and potential scarring of the intrauterine lining (Asherman's syndrome). This is an important consideration for women who would like to have children in the future and want to preserve their fertility and reduce the chance of future obstetric complications.

Prevention[link]

Currently there is no known way to prevent an impending abortion, however, fertility experts believe that identifying the cause of the miscarriage may help prevent it from happening again in a future pregnancy.^[51] In one study, researchers found that use of the supplement dehydroepiandrosterone before and during pregnancy reduced the risk of pregnancy losses.^[52]

Epidemiology[link]

Determining the prevalence of spontaneous abortions is difficult. Many happen very early in the pregnancy, before a woman may know she is pregnant. Treatment of women without hospitalization means medical statistics misses many cases.^[15] Prospective studies using very sensitive early pregnancy tests have found that 25% of pregnancies abort by the sixth week LMP (since the woman's last menstrual period),^[53][54] however, other reports suggest higher rates. One fact sheet from the University of Ottawa states, "The incidence of spontaneous abortion is estimated to be 50% of all pregnancies, based on the assumption that many pregnancies abort spontaneously with no clinical recognition."^[55] The NIH reports, "It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15–20%."^[56] Clinical abortions (those occurring after the sixth week LMP) occur in 8% of pregnancies.^[54]

The risk of aborting decreases sharply after the 10th week LMP, i.e., when the fetal stage begins.^[57] The loss rate between 8.5 weeks LMP and birth is about two percent; loss is “virtually complete by the end of the embryonic period."^[58]

The prevalence increases considerably with age of the parents. One study found that pregnancies from men younger than 25 years are 40% less likely to end in spontaneous abortion than pregnancies from men 25–29 years. The same study found that pregnancies from men older than 40 years are 60% more likely to end in spontaneous abortion than the 25–29-year age group.^[59] Another study found that the increased risk in pregnancies from older men is mainly seen in the first trimester.^[60] Yet another study found an increased risk in women, by the age of 45, on the order of 800% (compared to the 20–24 age group in that study), 75% of pregnancies ended in spontaneous abortion.^[61]

In other animals[link]

Abortion occurs in all animals that experience pregnancy. There are a variety of known risk factors for it in non-human animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.^[62] In cows, spontaneous abortion may be caused by contagious disease, such as Brucellosis or Campylobacter, but often can be controlled by vaccination.^[63] Other diseases are also known to make animals susceptible. Spontaneous abortion occurs in pregnant Prairie Voles when their mate is removed and they are exposed to a new male,^[64] an example of the Bruce effect, although this effect is seen less in wild populations than in the laboratory.^[65] Female mice who had spontaneous abortions showed a sharp rise in the amount of time spent with unfamiliar males preceding the abortion than those who did not abort.^[66]

ICD10 codes[link]

See also[link]

• Childbirth
• Stillbirth
• Pregnancy and Infant Loss Remembrance Day

References[link]

External links[link]

• Pregnancy loss support groups at the Open Directory Project
• UnspokenGrief ™.com | understanding & support for miscarriage survivors. support network

Avril Lavigne
Avril Lavigne during a performance in Italy, September 2011.
Background information
Birth name	Avril Ramona Lavigne
Born	(1984-09-27) 27 September 1984 (age 27) Belleville, Ontario, Canada
Origin	Napanee, Ontario, Canada
Genres	Pop rock, power pop, pop punk
Occupations	Singer-songwriter, Fashion Designer
Instruments	Vocals, guitar, piano, drums
Years active	2000–present
Labels	Epic, RCA, Arista
Associated acts	Evan Taubenfeld, Deryck Whibley
Website	www.avrillavigne.com
Notable instruments
Squier Signature Telecaster model guitar

Avril Ramona Lavigne (pronunciation: /ˈævrɨl ləˈviːn/; AV-ril lə-VEEN; born 27 September 1984) is a Canadian singer-songwriter. She was born in Belleville, Ontario, but spent most of her youth in the small town of Napanee. By the age of 15, she had appeared on stage with Shania Twain; by 16, she had signed a two-album recording contract with Arista Records worth more than $2 million. In 2002, when she was 17 years old, Lavigne broke onto the music scene with her debut album Let Go.

Let Go made Lavigne the youngest female soloist to reach No. 1 in the UK, and the album was certified four-times platinum by the Recording Industry Association of America. By 2009, over 16 million copies had been sold worldwide. Her breakthrough single, "Complicated", peaked at No. 1 in many countries around the world, as did the album Let Go. Her second album, Under My Skin, was released in 2004 and was her first album to peak at No. 1 on the U.S. Billboard 200, eventually selling more than 10 million copies worldwide. The Best Damn Thing, Lavigne’s third album, was released in 2007, becoming her third No. 1 album in the UK Albums Chart and featuring her first U.S. Billboard Hot 100 No. 1 single, "Girlfriend". Lavigne has scored six number-one singles worldwide, including "Complicated", "Sk8er Boi", "I'm with You", "My Happy Ending", "Nobody's Home", and "Girlfriend". With more than 30 million copies of her albums sold worldwide, Lavigne is one of the top-selling artists releasing albums in the U.S., with over 10.25 million copies certified by the RIAA. Her fourth studio album, Goodbye Lullaby, was released in March 2011. Goodbye Lullaby gave Lavigne her fourth top 10 album on the U.S. Billboard 200 and the UK Albums Chart and her third No. 1 album in both Japan and Australia. Three months after the release of Goodbye Lullaby, Lavigne began work on her fifth album, which will be released on Epic Records following her departure from RCA Records.

Lavigne branched out from recording music, pursuing careers in feature film acting and designing clothes and perfumes. She voiced a character in the animated film, Over the Hedge, in 2006. That same year, she made her on-screen feature film debut in Fast Food Nation. In 2008, Lavigne introduced her clothing line, Abbey Dawn, and in 2009, she released her first perfume, Black Star, which was followed by her second perfume, Forbidden Rose, in 2010 and her third perfume, Wild Rose, in 2011. In July 2006, Lavigne married her boyfriend of two years, Deryck Whibley, lead singer and guitarist for Sum 41. The marriage lasted a little over three years, and in October 2009, Lavigne filed for divorce. Whibley and Lavigne continued to work together, with Whibley producing her fourth album, as well as Lavigne's single, "Alice", written for Tim Burton's film Alice in Wonderland.

Early life[link]

Avril Ramona Lavigne was born in Belleville, Ontario. Her father, Jean-Claude Lavigne, named her "Avril" after the French word for the month of April. At the age of two, she began singing church songs with her mother,^[1] Judith-Rosanne "Judy" (née Loshaw). Judy recognized her two-year-old daughter's talents after hearing her sing "Jesus Loves Me" in church.^[2] Lavigne has an older brother, Matthew, and a younger sister, Michelle,^[3] both of whom teased her when she sang. "My brother used to knock on the wall because I used to sing myself to sleep and he thought it was really annoying."^[2]

When Lavigne was five years old, the family moved to Napanee, Ontario,^[1] a town with a population of approximately 5,000.^[4][5][6] Although she struggled to pay attention in school, sometimes being kicked out of class for misbehaving, her parents supported her singing. Her father bought her a microphone, a drum kit, a keyboard, and several guitars, and converted their basement into a studio. When Lavigne was 14, her parents would take her to karaoke sessions.^[7] Lavigne also performed at country fairs, singing songs by Garth Brooks, The Dixie Chicks, and Shania Twain. She also began writing her own songs. Her first song was called "Can't Stop Thinking About You", about a teenage crush, which she described as "cheesy cute".^[8]

In 1999,^[9] Lavigne won a radio contest to perform with fellow Canadian singer Shania Twain at the Corel Centre (now Scotiabank Place) in Ottawa, before an audience of 20,000 people.^[1][4] Twain and Lavigne sang "What Made You Say That",^[1] and Lavigne told Twain that she was going to be "a famous singer".^[4] During a performance with the Lennox Community Theatre, Lavigne was spotted by local folksinger Stephen Medd. He invited her to contribute vocals on his song, "Touch the Sky", for his 1999 album, Quinte Spirit. She later sang on "Temple of Life" and "Two Rivers" for his follow-up album, My Window to You, in 2000. In December 1999, Lavigne was discovered by her first professional manager, Cliff Fabri, while singing country covers at a Chapters bookstore in Kingston, Ontario.^[1][4] Fabri sent out VHS tapes of Lavigne's home performances to several industry prospects, and Lavigne was visited by several executives.^[10] Mark Jowett, co-founder of the Canadian management firm Nettwerk, received a copy of Lavigne's karaoke performances recorded in her parents' basement.^[11] Jowett arranged for Lavigne to work with Peter Zizzo during the summer of 2000 in New York, where she wrote the song "Why". Lavigne was noticed by Arista Records on a subsequent trip to New York.^[10]

Lavigne would go on to sell more than 30 million copies of her albums worldwide,^[12] becoming one of the top-selling artists releasing albums in the U.S., with over 10.25 million copies certified by the RIAA.^[13] In 2009, Billboard named Lavigne the No. 10 pop artist in the "Best of the 2000s" chart.^[14] She was listed as the 28th overall best act of the decade based on album and single chart performance in the U.S.^[15]

Music career[link]

[edit] 2000–03: Let Go

In November 2000,^[5] Ken Krongard, an A&R representative, invited Antonio "L.A." Reid, then head of Arista Records, to producer Peter Zizzo's Manhattan studio to hear Lavigne sing. Her 15-minute audition "so impressed" Reid that he immediately signed her to Arista with a deal worth $1.25 million for two albums and an extra $900,000 for a publishing advance.^[6][1] By this time, Lavigne had found that she fit in naturally with her hometown high school's skater clique, an image that carried through to her first album, but although she enjoyed skateboarding, school left her feeling insecure. Armed with a record deal, she dropped out to focus on her music career,^[5] but she still had to inform her parents of her decision. "I wasn't going to turn [the record deal] down. It's been my dream all my life. They knew how much I wanted this and how much I've put into it."^[16][8]

Reid gave A&R Joshua Sarubin the responsibility for overseeing Lavigne's development and the recording of her debut album.^[17] They spent several months in New York working with different co-writers trying to forge an individual sound for her. Sarubin told HitQuarters that for while they struggled finding her sound and although early collaborations with songwriter-producers including Sabelle Breer, Curt Frasca and Peter Zizzo resulted in some good songs, they didn't match her and her voice.^[17] It was only when Lavigne then went to Los Angeles in May 2001 and created two songs with The Matrix production team – including "Complicated" – that the record company felt she had made a major breakthrough.^[17] Lavigne then worked further with The Matrix and also with singer-songwriter Cliff Magness. Recording finished in January 2002.^[17]

Lavigne released her debut album, Let Go, on 4 June 2002 in the U.S., where it reached No. 2 on the Billboard 200. It peaked at No. 1 on the Australian, Canadian, and UK charts. This made Lavigne, at 17 years old, the youngest female soloist to have a No. 1 album in the UK until that time.^[18] By the end of 2002, the album was certified four-times platinum by the RIAA, making her the bestselling female artist of 2002 and Let Go the top-selling debut of the year.^[19] By May 2003, Let Go had accumulated over 1,000,000 sales in Canada, receiving a diamond certification from the Canadian Recording Industry Association.^[20] As of 2009, the album has sold over 16 million units worldwide,^[21] and the RIAA has certified the album six-times platinum, denoting shipments of over six million units in the U.S.^[22]

Lavigne's debut single and the album's lead single, "Complicated", peaked at No. 1 in Australia and No. 2 in the U.S. "Complicated" was one of the bestselling Canadian singles of 2002, and it was also featured on the teen television show, Dawson's Creek. "Complicated" later ranked on the Hot 100 Singles of the Decade list at No. 83.^[23]

Subsequent singles, "Sk8er Boi" and "I'm With You" reached the top ten in the U.S.^[24] Thanks to the success of her first three singles, Lavigne was the second artist in history to have three No. 1 songs from a debut album on the Billboard Mainstream Top 40.^[25] For the music video to "Complicated", Lavigne was named Best New Artist at the 2002 MTV Video Music Awards.^[26] She won four Juno Awards in 2003 out of six nominations,^[27] received a World Music Award for "World's Bestselling Canadian Singer", and was nominated for eight Grammy Awards, including Best New Artist and Song of the Year for "Complicated" (2003).^[28]

In 2002, Lavigne made a cameo appearance in the music video to "Hundred Million" by the pop punk band Treble Charger.^[29] In March 2003, Lavigne posed for the cover of Rolling Stone magazine^[30] and, later in May,^[31] performed "Fuel" during MTV's Icon tribute to Metallica.^[32] During her first headlining tour, the Try To Shut Me Up Tour, Lavigne covered Green Day's "Basket Case".^[33]

Lavigne was featured in the 2003 game, The Sims: Superstar, as a non-playable celebrity.^[34]

[edit] 2004–05: Under My Skin

Lavigne in Vancouver, Canada during the Live and By Surprise mall tour

Lavigne co-wrote "Breakaway" with Matthew Gerard, which was recorded by Kelly Clarkson for the soundtrack to the 2004 film The Princess Diaries 2: Royal Engagement.^[35] "Breakaway" would later be included on Clarkson's second album and released as the album's lead single. Lavigne covered the Goo Goo Dolls song "Iris", performed with the band's lead singer John Rzeznik at Fashion Rocks,^[36] and she posed for the cover of Maxim in October 2004.^[37] She also recorded the theme song for The SpongeBob SquarePants Movie. "I made the song a little more edgy", Lavigne said. "There are a lot of loud guitars, and we picked the tempo up a little and sang it with a little more attitude." Lavigne rearranged the song with the help of producer Butch Walker.^[38]

Lavigne's second studio album, Under My Skin, was released on 25 May 2004, debuting at No. 1 in several countries, including Australia, Mexico, Canada, Japan, the UK, and the U.S.^[39] The album has sold more than 10 million copies. Lavigne wrote most of the album's tracks with Canadian singer-songwriter Chantal Kreviazuk. Kreviazuk's husband, Our Lady Peace front man Raine Maida, co-produced the album, along with Butch Walker and Don Gilmore. Lavigne went on the Live and By Surprise twenty-one-city mall tour in the US and Canada to promote the album, accompanied by her guitarist, Evan Taubenfeld. Each performance consisted of a short live acoustic set of songs from the new album. At the end of 2004, Lavigne embarked on her first world tour, the Bonez Tour, which had stopovers in almost every continent and lasted for the entire 2005 year.

"Don't Tell Me", the lead single of the album, went to No. 1 in Argentina and Mexico and reached the top five in the UK and Canada and the top ten in Australia and Brazil. "My Happy Ending", the album's second single, went to No. 1 in Mexico and the top five in the UK and Australia. In the US, it reached the top ten of the Billboard Hot 100 and went to No. 1 in the Mainstream Top 40, making it her fourth-biggest hit there. The third single, "Nobody's Home", did not make the top 40 in the US, reaching No. 1 only in Mexico and Argentina. The fourth single from the album, "He Wasn't", reached top 40 positions in the UK and Australia and was not released in the U.S.^[41]

Lavigne won two World Music Awards in 2004 for "World's Best Pop/Rock Artist" and "World's Bestselling Canadian Artist". She received five Juno Award nominations in 2005, and picked up three, including "Artist of the Year". She won the award for "Favorite Female Singer" at the eighteenth annual Nickelodeon Kids' Choice Awards^[42] and was nominated in every MTV Award show shown around the world.

[edit] 2006–08: The Best Damn Thing

On 26 February 2006, Lavigne represented Canada at the closing ceremony of the Torino Olympics, performing her song "Who Knows" during the eight minute Vancouver 2010 portion.^[43]

While Lavigne was in the studio for her third studio album, Fox Entertainment Group approached her to write a song for the soundtrack to the 2006 fantasy-adventure film Eragon. She wrote and recorded two "ballad-type" songs, but only one, "Keep Holding On", was used for the film.^[44] Lavigne admitted that writing the song was challenging, making sure it flowed with the film. She emphasized that "Keep Holding On", which later appeared on the album, was not indicative of what the next album would be like.^[45][46]

Lavigne in 2008 performing in the Netherlands.

Lavigne's third album, The Best Damn Thing, was released on 17 April 2007, which Lavigne immediately promoted with a small tour. Its lead single, "Girlfriend", topped the Billboard Hot 100 the same week The Best Damn Thing debuted at No. 1 on the Billboard 200 chart. "Girlfriend" was Lavigne's first single to reach this No. 1 position.^[47] The single was a worldwide hit; it also peaked at No. 1 in Australia, Canada, Japan, and Italy and reached No. 2 in the UK and France. "Girlfriend" was recorded in Spanish, French, Italian, Portuguese, German, Japanese, and Mandarin. The International Federation of the Phonographic Industry ranked "Girlfriend" as the most-downloaded track worldwide in 2007, selling 7.3 million copies, including the versions recorded in eight different languages.^[48][12] "Girlfriend" ranked on the Hot 100 Singles of the Decade list at No. 94.^[49]

"When You're Gone", the second single, went to No. 3 in the UK, the top five in Australia and Italy, the top ten in Canada, and was close to reaching the top twenty in the U.S. In December 2007, Lavigne, with annual earnings of $12 million, was ranked number eight in the Forbes "Top 20 Earners Under 25".^[50] "Hot" was the third single and has been Lavigne's least successful single in the U.S., charting only at No. 95. In Canada, "Hot" made the top ten, and in Australia, the top 20. The Best Damn Thing has sold over 6 million copies worldwide.

During this era, Lavigne won nearly every award she was nominated for, including two World Music Awards for "World's Bestselling Canadian Artist" and "World's Best Pop/Rock Female Artist". She took her first two MTV Europe Music Awards, received one Teen Choice Awards for "Summer Single", and was nominated for five Juno awards.

In mid-2007, Lavigne was featured in a two-volume graphic novel, Avril Lavigne's Make 5 Wishes. She collaborated with artist Camilla D’Errico and writer Joshua Dysart on the manga, which was about a shy girl named Hana who, upon meeting her hero Avril Lavigne, learned to overcome her fears. Lavigne said, "I know that many of my fans read manga, and I'm really excited to be involved in creating stories that I know they will enjoy." The volumes were released on 10 April (one week prior to the release of The Best Damn Thing) and in July, respectively. The publication Young Adult Library Services nominated the series for "Great Graphic Novels for Teens".^[51]

In March 2008, Lavigne undertook a world tour named The Best Damn Tour to support the album. In that same month, she also appeared on the cover of Maxim for the second time of her career.^[52] In mid-August, Malaysia's Islamic opposition party, the Pan-Malaysian Islamic Party, attempted to ban Lavigne's show in Kuala Lumpur, judging her stage moves "too sexy". Her concert on 29 August was considered as promoting wrong values ahead of Malaysia's independence day on 31 August.^[53] On 21 August 2008, MTV reported that the concert had been approved by the Malaysian government.^[54]

[edit] 2009–11: Goodbye Lullaby

Lavigne singing in Florida during her Black Star Tour, May 2011.

Only a month after completing The Best Damn Tour, Lavigne began recording in her home studio in November 2008 with the song "Black Star",^[55] written to help promote her first fragrance of the same name.^[56] By July 2009, nine tracks had been recorded for the new album,^[55] including the songs "Fine", "Everybody Hurts" and "Darlin". Several of the tracks were written in Lavigne's youth. "Darlin" was the second song Lavigne wrote as a 15-year-old while living in Napanee, Ontario. Lavigne described the album as being about "life". She stated, "It's so easy for me to do a boy-bashing pop song, but to sit down and write honestly about something that's really close to me, something I've been through, it's a totally different thing."^[56] With the exception of the album's lead single, "What the Hell", Lavigne described the songs on the album as different from her earlier material: "I'm older now, so I think that comes across in my music, it's not as pop-rock".^[57]

In January 2010, while simultaneously writing and recording for her new album, Lavigne worked with Disney clothing designs inspired by Tim Burton's feature film, Alice in Wonderland. She asked the executives if she could write a song for the film. The result was the song "Alice",^[58] which was played over the end credits^[59] and included on the soundtrack, Almost Alice.^[60]

On 28 February, Lavigne gave a performance at the concert portion of the Vancouver 2010 Winter Olympics closing ceremony, performing "My Happy Ending" and "Girlfriend".^[61] Lavigne was honoured to perform at the ceremonies, but she regretted not being able to attend the U.S. vs. Canada hockey match. "They had us on lockdown. We weren't allowed to leave our trailers, for security purposes."^[62]

In September 2010, Lavigne's third single from her debut album, "I'm With You", was sampled by Rihanna on the track "Cheers (Drink to That)", which is featured on Rihanna's fifth studio album, Loud.^[63][64] In August 2011, she was featured in the music video for Cheers (Drink To That). "It's exciting to me because that was always one of my favorite songs, and for it to come out 10 years ago and so now to have it sampled and back out on the radio is pretty dope".^[65] In December 2010, American singer Miranda Cosgrove released "Dancing Crazy", a song written by Lavigne, Max Martin and Shellback. It was also produced by Martin.^[66] On 23 September 2011, Lavigne appeared in the Hub network show Majors & Minors as a guest mentor, alongside other singers including Adam Lambert and Leona Lewis. About the show, Lavigne stated, "I sang for them, and they performed for me. I was just blown away. I got to talk to them about music and the music industry, and they were all just so excited".^[65]

The release dates for Goodbye Lullaby and its lead single were pushed back several times. In response to these delays, Lavigne said, "I write my own music and, therefore, it takes me longer to put out records 'cause I have to live my life to get inspiration",^[67] and that she had enough material for two records.^[67] In November, Lavigne was featured in Maxim, where she revealed that Goodbye Lullaby took two and a half years to complete,^[68] but she cited her record company as the reason for the album's delays, stating that the album had been completed for a year.^[69] Goodbye Lullaby was released on 8 March.^[70][57] The lead single, "What the Hell", premiered on Dick Clark's New Year's Rockin' Eve on 31 December.^[70]

2011–present: Fifth studio album[link]

Three months after the release of Goodbye Lullaby, Lavigne announced that work on her fifth studio album had already begun, with eight songs written so far. The new album will musically be the opposite of Goodbye Lullaby, with a release date rumored for sometime in 2012. ^[71] Lavigne explained, "[Goodbye Lullaby] was more mellow, [but] the next one will be pop and more fun again. I already have a song that I know is going to be a single, I just need to re-record it!"^[72][73][74] Later, in July 2011, Lavigne revealed the title of two of the songs from her fifth album as "Fine" and "Gone". The tracks were originally recorded for Goodbye Lullaby but never made the final cut. In late 2011, Lavigne confirmed that she had moved to Epic Records, which is now headed by L.A. Reid.^[75][76]

Production-wise, Lavigne stated in an interview with Virgin Radio 96 that she would begin production on the album in January 2012. ^[65] During recording, she has been confirmed to have worked with the hip hop production duo The Runners, ^[77] Chad Kroeger of rock band Nickelback and former member of rock band Evanescence David Hodges. ^[78] In April 2012, Lavigne confirmed that she had "finally" finished work on her fifth album and that she would be taking a short hiatus before releasing it and embarking on "[her] next artistic journey".^{[citation needed]}

Musical style and songwriting[link]

Avril Lavigne in February 2011.

Themes in Lavigne's music include messages of self-empowerment from a female or an adolescent view.^[79] Lavigne believes her "songs are about being yourself no matter what and going after your dreams even if your dreams are crazy and even if people tell you they're never going to come true."^[80] On her debut album, Let Go, Lavigne preferred the less mainstream songs, such as "Losing Grip", instead of her more radio-friendly singles, such as "Complicated", saying that "the songs I did with the Matrix... were good for my first record, but I don't want to be that pop anymore."^[81] Lavigne's second album, Under My Skin, had deeper personal themes underlying each song. Lavigne explained, "I've gone through so much, so that's what I talk about.... Like boys, like dating or relationships".^[82] In contrast, her third album, The Best Damn Thing, was not personal to her. "Some of the songs I wrote didn't even mean that much to me. It's not like some personal thing I'm going through."^[83] Her objective in writing the album was simply to "make it fun".^[84] Goodbye Lullaby, Lavigne's fourth album, was much more personal than her earlier records,^[55] with Lavigne describing the album as "more stripped down, deeper. All the songs are very emotional".^[85] Ian McKellen defined her as “... a punk chanteuse, a post-grunge valkyrie, with the wounded soul of a poet and the explosive pugnacity of a Canadian.” on the Craig Ferguson show in 2007. ^[86][87]

Growing up, Lavigne listened to Blink-182, Goo Goo Dolls, Matchbox Twenty and Shania Twain,^[81] and her influences include Courtney Love and Janis Joplin.^[82] Because of these influences, musical genres, and her personal style, the media often defined her as punk, something she denied being. Lavigne’s close friend and guitarist, Evan Taubenfeld, said, "It's a very touchy subject to a lot of people, but the point is that Avril isn't punk, but she never really pretended to claim to come from that scene. She had pop punk music and the media ended up doing the rest".^[88] Lavigne also commented on the matter: "I have been labeled like I'm this angry girl, [a] rebel... punk, and I am so not any of them."^[40]

Most of critics identify Lavigne as some form between teen pop and pop-punk: Publications such as The New York Times, Rolling Stone, NME, MusicMight, IGN and Popmatters have identified Avril Lavigne as a mix of rock, teen pop and pop-punk,^{[89][90][91][92][93][94]} influenced by a grungey pop-rock sound.^{[95][96][97][98][99]}

While Lavigne denied being angry, her interviews were still passionate about the media's lack of respect for her songwriting. "I am a writer, and I won't accept people trying to take that away from me", adding that she had been writing "full-structured songs" since she was 14.^[40] Despite this, Lavigne’s songwriting has been questioned throughout her career. The songwriting trio, the Matrix, with whom Lavigne wrote songs for her debut album, claimed that they were the main songwriters of Lavigne’s singles, "Complicated", "Sk8er Boi" and "I'm with You". Lavigne denied this, asserting that she was the primary songwriter for every song on the album. "[N]one of those songs aren't from me".^[81] In 2007, Chantal Kreviazuk, who wrote with Lavigne on her second album, accused Lavigne of plagiarism^[100] and criticized her songwriting. "Avril doesn't really sit and write songs by herself or anything".^[101] Lavigne also disclaimed this, and considered taking legal action against Kreviazuk for "clear defamation" against her character.^[101] Kreviazuk later apologized: "Avril is an accomplished songwriter and it has been my privilege to work with her".^[100] Shortly after that, Tommy Dunbar, founder of the 1970s band, the Rubinoos, sued Lavigne, her publishing company, and Lukasz "Dr. Luke" Gottwald for allegedly stealing parts of "I Wanna Be Your Boyfriend" for her song "Girlfriend".^[102] Gottwald defended Lavigne, stating, "me and Avril wrote the song together…. It has the same chord progressions as ten different Blink-182 songs, the standard changes you'd find in a Sum 41 song. It's the Sex Pistols, not the Rubinoos."^[101] In January 2008, the lawsuit was closed after a confidential settlement had been reached.^[103]

Other work[link]

Film career[link]

Lavigne became interested in appearing on television and in feature films. The decision, she said, was her own. Although her years of experience in making music videos would be to her advantage, Lavigne admitted her experience in singing removed any fear of performing on camera. She specifically mentioned that the video "Nobody's Home" involved the most "acting".^[80] Her first television appearance was in a 2002 episode of Sabrina, the Teenage Witch,^[104] performing "Sk8er Boi"^[105] with her band in a nightclub.^[106] She later made a cameo appearance in the 2004 film Going the Distance. The main characters bump into her backstage at the MuchMusic Video Awards^[107] after her performance of "Losing Grip".^[108]

Lavigne at the Los Angeles premiere of Over the Hedge on 30 April 2006.

She moved into feature film acting cautiously, choosing deliberately small roles to begin with. In November 2005, after going through an audition to land the role, Lavigne travelled to New Mexico^[109] to film a single scene in the 2007 film, The Flock.^[110] She starred as Beatrice Bell, the girlfriend of a crime suspect, appearing alongside Claire Danes and Richard Gere. Gere gave Lavigne acting tips between takes.^[110] On her role in The Flock, Lavigne said, "I did that just to see how it was and to not jump into [mainstream acting] too fast".^[80] The Flock would not be released in American theatres, and because it would not be released in foreign markets until late 2007, it would not be considered Lavigne's debut. The film made $7 million in the foreign box office.^[111]

Lavigne's feature film debut was voicing an animated character in the 2006 film Over the Hedge, based on the comic strip of the same name. She voiced the character Heather, a Virginia Opossum. Recording the characters' voices was devoid of interaction with other actors. Lavigne stated, "All the actors went in individually, and [director] Tim and [screenwriter Karey] and directors were there with me every time I went in, and they made it go so smoothly; they made me feel comfortable.... That was the interesting part, going in by yourself, with no one else to kind of feed off of."^[112] Lavigne found the recording process to be "easy" and "natural", but she kept hitting the microphone as she gestured while acting. "I'd use my hands constantly and, like, hit the microphone stand and make noises, so Tim and Karey had to tell me to hold still.... It's hard to be running or falling down the stairs and have to make those sounds come out of your mouth but keep your body still." Lavigne believed she was hired to perform Heather because of her rock-star status. "[The director] thought I'd give my character... a bit of attitude".^[80] The film opened on 19 May 2006, making $38 million over its opening weekend. It went on to gross $336 million worldwide.^[113]

In December 2005, Lavigne signed on to appear in Fast Food Nation, based on the book Fast Food Nation: The Dark Side of the All-American Meal.^[114] The fictionalized adaptation, directed by Richard Linklater, traces fast-food hamburgers contaminated with cow feces back to the slaughterhouses.^[115] Lavigne starred in her on-screen acting debut^[116] as a high school student intent on freeing the cows.^[117] The film opened on 17 November 2006 and remained in theatres for 11 weeks, grossing $2 million worldwide.^[118]

Both Over the Hedge and Fast Food Nation opened at the 2006 Cannes Film Festival, which Lavigne attended. Lavigne felt honoured to be able to attend and was proud of her work. When asked if she would pursue her film career, she stated that she wanted to take her time and wait for the "right parts and the right movies." Lavigne was aware of the roles she had chosen. "I wanted to start off small and to learn [that] I wouldn't just want to throw myself into a big part."^[80] In August 2006, Canadian Business magazine ranked her as the seventh top Canadian actor in Hollywood in their second-annual ranking Celebrity Power List. The results were determined by comparing salary, Internet hits, TV mentions, and press hits.^[119]

Fashion design[link]

Avril Lavigne sporting clothes from her Abbey Dawn line in 2011.

In July 2008, Lavigne launched the clothing line Abbey Dawn, featuring a back-to-school collection.^[12] It is produced by Kohl's, which is the brand's exclusive U.S. retailer. Named after Lavigne's childhood nickname, Abbey Dawn is designed by Lavigne herself.^[120][121] Kohl's describes Abbey Dawn as a "juniors lifestyle brand",^[12] which incorporates skull, zebra, and star patterns, purples and "hot pinks and blacks". Lavigne, who wore some of the clothes and jewellery from her line at various concerts before its official launch, pointed out that she was not merely licensing her name to the collection. "I actually am the designer. What's really important to me is that everything fits well and is well-made, so I try everything on and approve it all."^[122] The clothing line incorporates Lavigne's musical style and lyrics, "after the release of my first album, I realized how much fashion was involved in my musical career".^[65]

The designs were also featured on the Internet game Stardoll, where figures can be dressed up as Avril Lavigne.^[124] On 14 September 2009, Lavigne took her then latest collection for her clothing line to be a part of the New York Fashion Week,^[125] returning in 2011.^[65] In December 2010, the clothing line was made available to over 50 countries through the line's official website.^[126][85] "It's fun to be a chick and design clothes and things I'd like for myself. I design things I [can't] find."^[62] At the end of 2008, Lavigne signed a contract with Canon Canada to appear in advertising campaigns and commercials to promote the latest line of cameras and a full range of other accessories.^[127]

Lavigne released her first fragrance, Black Star, created by Procter & Gamble Prestige Products. The fragrance was announced on Lavigne's official website on 7 March 2009. Black Star, which features notes of pink hibiscus, black plum and dark chocolate, was released in summer 2009 in Europe, and later in the US and Canada.^[128] When asked what the name meant, Lavigne replied, "I wanted [the bottle] to be a star, and my colors are pink and black, and Black Star resembles being different, and standing out in the crowd, and reaching for the stars; the whole message is just about following your dreams, and it's okay to be unique and be who you are."^[129] Black Star won the 2010 Best "Women's Scent Mass" by Cosmetic Executive Women (CEW).^[130] Black Star was followed by a second fragrance in July 2010,^[131] Forbidden Rose, which took two years to develop.^[132] It features notes of red apple, winepeach, black pepper, lotusflower, heliotrope, shellflower, praline agreement, sandalwood, and vanilla.^[131] Its message is an extension of Black Star's "follow your dreams",^[133] though the tagline for the new perfume is "Dare to Discover".^[134] The commercial takes place in a gothic garden setting,^[133] where Lavigne, upon entering the garden, finds a single, purple rose.^[134] Lavigne launched a third fragrance, Wild Rose, in August 2011 and filmed the commercial for it in late 2010.^[85] The tagline for the fragrance is "Dare to discover more".^[135] It features notes of mandarin, pink grapefruit, plum, orange blossom, frangipani, blue orchid, musk, sandalwood and crème brûlée.^[136]

In January 2010, Lavigne began working with Disney to incorporate Alice in Wonderland-inspired designs into her Abbey Dawn line of clothing.^[58] Her designs were exhibited at the Fashion Institute of Design & Merchandising in California beginning in May through September, alongside Colleen Atwood's costumes from the 2010 film.^[137]

Philanthropy[link]

Lavigne singing in Beijing in 2008.

Lavigne has been involved with many charities, including Make Some Noise, Amnesty International, Erase MS, AmericanCPR.org, Camp Will-a-Way, Music Clearing Minefields, U.S. Campaign for Burma, Make-a-Wish Foundation and War Child. She has also appeared in ALDO ads with YouthAIDS to raise money to educate people worldwide about HIV/AIDS. Lavigne took part in the Unite Against AIDS concert presented by ALDO in support of Unicef on 28 November 2007 at the Bell Centre in Montreal, Quebec, Canada.^[138] In November 2010, Lavigne attended the Clinton Global Initiative.^[139]

Lavigne worked with Reverb, a non-profit environmental organization, for her 2005 east coast tour.^[140] She covered "Knockin' on Heaven's Door" for War Child's Peace Songs compilation, and she recorded a cover of the John Lennon song "Imagine" as her contribution to the compilation album Instant Karma: The Amnesty International Campaign to Save Darfur. Released on 12 June 2007, the album was produced to benefit Amnesty International's campaign to alleviate the crisis in Darfur.^[141]

On 5 December 2009, Lavigne returned to the stage in Mexico City during the biggest charity event in Latin America, "Teleton". She performed acoustic versions of her hits "Complicated" and "Girlfriend" with Evan Taubenfeld and band member, Jim McGorman.^[142] In 2010, Lavigne was one of several artists who contributed their voices to a cover of K'naan's "Wavin' Flag" as a benefit single to help raise money for several charity organizations related to the 2010 Haiti earthquake.^[143]

On 14 September 2010, Lavigne introduced her charity, "The Avril Lavigne Foundation". The next day, the foundation's official website was launched. The foundation aims to help young people with serious illnesses and disabilities^[139][144] and works with leading charitable organizations;^[126] The foundation partners with the Easter Seals, Make-A-Wish foundation and Erase MS,^[145] the latter two being charities Lavigne has previously worked with. Her work with the Make-A-Wish foundation was the inspiration behind her own charity, with Lavigne stating, "I just really wanted to do more".^[144] Lavigne said on the foundation's website, "I have always looked for ways to give back because I think it’s a responsibility we all share".^[146] Philanthropist Trevor Neilson's 12-person firm, "Global Philanthropy Group", advises Lavigne with her foundation as well as several other celebrities, including musician John Legend.^[139]

Personal life[link]

Public image[link]

When Lavigne first gained publicity, she was known for her tomboyish style,^[147] in particular her necktie-and-tank-top combinations.^[148][149] She preferred baggy clothes, skater shoes or Converses,^[62] wristbands, and sometimes shoelaces wrapped around her fingers.^[7] During photo shoots, instead of wearing "glittery get-ups", she preferred wearing "old, crumpled T's".^[5] In response to her fashion and musical influences, the media would call her the "pop punk princess".^[150][151] Press and fans regarded her as the "anti-Britney", in part because of her less commercial and "real" image, but also because she was noticeably headstrong. "I’m not made up and I’m not being told what to say and how to act, so they have to call me the anti-Britney, which I’m not."^[7] By November 2002, however, Lavigne stopped wearing ties, claiming she felt she was "wearing a costume".^[6] Lavigne made a conscious effort to keep her music, and not her image, at the forefront of her career. "I'm just saying, I don't want to sell sex. I feel that's sort of lame and low. I've got so much more to say."^[152]

Lavigne eventually took on a more gothic style as she began her second album, Under My Skin, trading her skating outfits for black tutus^[151] and earning an image marked by angst.^[153] During The Best Damn Thing years, Lavigne changed directions. She dyed her hair blonde with a pink streak, wore feminine outfits,^[154] including "tight jeans and heels",^[62] and modelled for magazines such as Harper's Bazaar.^[147] Lavigne defended her new style: "I don't really regret anything. You know, the ties and the wife-beaters and all... It had its time and place. And now I'm all grown up, and I've moved on".^[154] She now tries to eat healthy foods and practises yoga, soccer, surfing, rollerblading, and street hockey.^[62]

Tattoos[link]

Lavigne's XXV and star tattoos on her right forearm, and 30, lightning bolt, and star tattoos on her left wrist.

Only a few of Lavigne's tattoos are unique to her; the rest are matched with those of her friends.^[62] Lavigne had a star tattooed on the inside of her left wrist that was created at the same time as friend and musical associate Ben Moody's identical tattoo.^[155] In late 2004, she had a small pink heart around the letter "D" applied to her right wrist, which represented her then-boyfriend, Deryck Whibley.^[62][156] Lavigne and then-husband Whibley got matching tattoos in March 2010, in celebration of his 30th birthday.^[62] In April, Lavigne added another tattoo on her wrist: that of a lightning bolt and the number 30.^[157]