Monthly Archives: March 2022
07 Mar 2022
My Story – Breast cancer and the Menopause.
The Latte Lounge is wanting to support women by sharing real-life menopause stories. This story is written by Jackie Woolf.
I always thought that by the time I reached my 50s, I would be sorted – calm, happy and accepting of who I was and maybe even love myself a little.
But I was wrong.
Instead, I’ve been moody, mad and miserable.
In a nutshell, the most I’d ever known about the menopause was that it involved a flush or two, and then it was over.
And with so little spoken of it, I can see why that was the case.
The first time I experienced a hot flush, it was not one of my own. It belonged to a lady on the train. I was young and curious and recall being captivated as I watched her turn crimson right before my eyes.
The second flush did belong to me and it occurred in my mid-thirties as a result of treatment for breast cancer.
The potency of the drugs affected my ovaries and threw me into a temporary state of menopause.
Thankfully my treatment was successful, my cycles returned to normal and life moved on – though it was never quite the same. I’m not sure it ever is after a cancer diagnosis.
As for the menopause, I didn’t recall giving it another thought until some 15 years later, when it became apparent that my periods were less frequent.
Then they stopped. And I was menopausal, I think.
Or was I ‘pre’? Or even ‘post’?
Learning I carried the BRCA gene
I still find the stages of menopause to be somewhat confusing and like to refer to them simply as ‘the menopause’ with no ‘pre’ and no ‘post’. This requires less effort on my part, plus it keeps things simple for my brain.
Not long after, I learned that I carried the BRCA gene, for which the suggested course of action was a) removal of my breasts and b) removal of my ovaries – more formally known as an oophorectomy.
And with that knowledge, I sailed straight into my gynaecologist’s office and asked him to ‘whip ‘em out’.
My ovaries, that is. Plus their respective tubes.
My speedy decision was based on the fact that I was already menopausal and no longer needed them.
The breast decision was a longer process.
The oophorectomy went well, I recovered well and other than experiencing some mild symptoms of what I considered the ‘ageing process,’ all was well in my ovary-less world.
And I was grateful for that.
But as time went on, and the months passed by, my ‘ageing’ symptoms gathered a worrying momentum and a power of strength.
Symptoms after treatment and going through the menopause
I was sleepless and overtired, and I was also very hot.
I was angry and moody, and I felt miserable a lot. And I’d lost my zest for life.
Getting old is hard, I concluded.
The process sucks.
However, early one morning at the height of summer, and in the midst of a dramatic mood swing, I had a moment of clarity.
And my penny dropped.
I saw that what I’d thought were signs of ageing and a natural part of life were not that at all. Something else was at play.
The ‘M’ word.
And its entourage of symptoms.
At first I kept my findings quiet, as a secret just for me. I was embarrassed, I think, and partly ashamed and so silence was key.
But as things got tougher (and as I got hotter), I started to share what I was going through. To my surprise, this paved the way for other women – and even the occasional man – to share, too.
I was reminded of how important and reassuring it is to know that we are not alone in how we think and feel and that somewhere out there, another human being is experiencing the same thing – not only in menopause but also in life.
Unexpectedly, I began to keep a diary where I noted all my thoughts. It later occurred to me that a great way to spread the word and possibly do some good in the world would be to share it. And so my mini-blog was born in the hope that it might add a touch of lightness and brightness to the subject, as well as help women know that they are not alone in the madness of the menopause or the mayhem of their lives.
It wasn’t long before I got a spring back in my step, woke up my creativity (which had been dormant for so long), and, most importantly, connected with fabulous like-minded women going through the same thing.
And as I started considering what other good might come in my menopausal years, I felt a wave of excitement I had not experienced in a long time.
Or possibly just a hot flush.
Written by: Jackie Woolf
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The Latte Lounge is an online platform for midlife women offering support, information and signposting for all your health and wellbeing needs.
Wearing shoes in the house is just plain gross. The verdict from scientists who study indoor contaminants
Published: March 16, 2022 2.57pm AEDT
- Mark Patrick Taylor Chief Environmental Scientist, EPA Victoria; Honorary Professor, Macquarie University
- Gabriel Filippelli Chancellor’s Professor of Earth Sciences and Executive Director, Indiana University Environmental Resilience Institute, IUPUI
Mark Patrick Taylor received funding via an Australian Government Citizen Science Grant (2017-2020), CSG55984 ‘Citizen insights to the composition and risks of household dust’ (the DustSafe project). He is an Honorary Professor at Macquarie University and a full time employee of EPA Victoria, appointed to the statutory role of Chief Environmental Scientist.
Gabriel Filippelli does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Macquarie University provides funding as a member of The Conversation AU.
IUPUI provides funding as a member of The Conversation US.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.You probably clean your shoes if you step in something muddy or disgusting (please pick up after your dog!). But when you get home, do you always de-shoe at the door?
Plenty of Australians don’t. For many, what you drag in on the bottom of your shoes is the last thing on the mind as one gets home.
We are environmental chemists who have spent a decade examining the indoor environment and the contaminants people are exposed to in their own homes. Although our examination of the indoor environment, via our DustSafe program, is far from complete, on the question of whether to shoe or de-shoe in the home, the science leans toward the latter.
It is best to leave your filth outside the door.
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What contaminants are in your home, and how did they get there?
People spend up to 90% of their time indoors, so the question of whether or not to wear shoes in the house is not a trivial one.
The policy focus is typically on the outdoor environment for soil, air quality and environmental public health risks. However, there is growing regulatory interest in the question of indoor air quality.
The matter building up inside your home includes not just dust and dirt from people and pets shedding hair and skin.
Some of the microorganisms present on shoes and floors are drug-resistant pathogens, including hospital-associated infectious agents (germs) that are very difficult to treat.
A roll-call of indoor nasties
Our work has involved the measurement and assessment of exposure to a range of harmful substances found inside homes including:
- antibiotic-resistant genes (genes that make bacteria resistant to antibiotics)
- disinfectant chemicals in the home environment
- the perfluorinated chemicals (also known as PFAS or “forever chemicals” because of their tendency to remain in the body and not break down) used ubiquitously in a multitude of industrial, domestic and food packaging products
- radioactive elements.
A strong focus of our work has involved assessing levels of potentially toxic metals (such as arsenic, cadmium and lead) inside homes across 35 nations (including Australia).
These contaminants – and most importantly the dangerous neurotoxin lead – are odourless and colourless. So there is no way of knowing whether the dangers of lead exposure are only in your soils or your water pipes, or if they are also on your living room floor.
The most likely reason for this connection is dirt blown in from your yard or trodden in on your shoes, and on the furry paws of your adorable pets.
This connection speaks to the priority of making sure matter from your outdoor environment stays exactly there (we have tips here).
A recent Wall Street Journal article argued shoes in the home aren’t so bad. The author made the point that E. coli – dangerous bacteria that develop in the intestines of many mammals, including humans – is so widely distributed that it’s pretty much everywhere. So it should be no surprise it can be swabbed on shoe bottoms (96% of shoe bottoms, as the article pointed out).
But let’s be clear. Although it’s nice to be scientific and stick with the term E. coli, this stuff is, put more simply, the bacteria associated with poo.
Whether it is ours or Fido’s, it has the potential to make us very sick if we are exposed at high levels. And let’s face it – it is just plain gross.
Why walk it around inside your house if you have a very simple alternative – to take your shoes off at the door?
On balance, shoeless wins
So are there disadvantages to having a shoe-free household?
Beyond the occasional stubbed toe, from an environmental health standpoint there aren’t many downsides to having a shoe-free house. Leaving your shoes at the entry mat also leaves potentially harmful pathogens there as well.
We all know prevention is far better than treatment and taking shoes off at the door is a basic and easy prevention activity for many of us.
Need shoes for foot support? Easy – just have some “indoor shoes” that never get worn outside.
There remains the issue of the “sterile house syndrome,” which refers to increased rates of allergies among children. Some argue it’s related to overly sterile households.
Indeed, some dirt is probably beneficial as studies have indicated it helps develop your immune system and reduce allergy risk.
But there are better and less gross ways to do that than walking around inside with your filthy shoes on. Get outside, go for a bushwalk, enjoy the great outdoors.
Just don’t bring the muckier parts of it inside to build up and contaminate our homes.
I have just returned to work last week after 3 weeks away, spent with my son and his family, who we had not seen for 3 1/2 years as they live in Japan, and Covid stopped all travel. Since being back, I have noticed that many of my patients, who had been doing well for many years, now complaining of symptoms, many related to hormonal/gynecological issues. This was puzzling. Nothing else had changed, except for Covid. I wondered whether the vaccine had caused these changes, and did some research on this issue. – all of these women had been vaccinated – what if the vaccine was the cause of these symptoms? The evidence shows that the mRNA vaccines do mess with women’s hormones – see the article below. This is the only logical conclusion I can make. I am not anti-vaccine – have had all 3, as have all of my family. However, we must remember that these are not vaccines in the usual sense. If you have Tetanus, Diphtheria, Smallpox (now extinct due to vaccination),Mumps, Measles and Rubella – you will not get the disease. This is not true for the Covid vaccines. They do not provide 100% protection, and over time this declines significantly. Could those of you who feel that the vaccine has had some sort of major negative reaction, please email me. I would like to know if I am correct. Unfortunately, there is strong pressure on doctors not to report any reactions to the Vaccine, as they do not want to give any ammunition to the ant-vaxxers. I would hope the authorities would be honest with the public and not try to hide the true extent of side-effects to the vaccines.
Menstrual changes after covid-19 vaccination
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2211 (Published 16 September 2021) Cite this as: BMJ 2021;374:n2211 Read our latest coverage of the coronavirus pandemic
- Victoria Male, lecturer in reproductive immunology
A link is plausible and should be investigated
Common side effects of covid-19 vaccination listed by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) include a sore arm, fever, fatigue, and myalgia.1 Changes to periods and unexpected vaginal bleeding are not listed, but primary care clinicians and those working in reproductive health are increasingly approached by people who have experienced these events shortly after vaccination. More than 30 000 reports of these events had been made to MHRA’s yellow card surveillance scheme for adverse drug reactions by 2 September 2021, across all covid-19 vaccines currently offered.1
Most people who report a change to their period after vaccination find that it returns to normal the following cycle and, importantly, there is no evidence that covid-19 vaccination adversely affects fertility. In clinical trials, unintended pregnancies occurred at similar rates in vaccinated and unvaccinated groups.2 In assisted reproduction clinics, fertility measures and pregnancy rates are similar in vaccinated and unvaccinated patients.3456
MHRA states that evaluation of yellow card reports does not support a link between changes to menstrual periods and covid-19 vaccines since the number of reports is low relative to both the number of people vaccinated and the prevalence of menstrual disorders generally.7 However, the way in which yellow card data are collected makes firm conclusions difficult. Approaches better equipped to compare rates of menstrual variation in vaccinated versus unvaccinated populations are needed, and the US National Institutes of Health has made $1.67m (£1.2m; €1.4m) available to encourage this important research.8
Menstrual changes have been reported after both mRNA and adenovirus vectored covid-19 vaccines,1 suggesting that, if there is a connection, it is likely to be a result of the immune response to vaccination rather than a specific vaccine component. Vaccination against human papillomavirus (HPV) has also been associated with menstrual changes.9 Indeed, the menstrual cycle can be affected by immune activation in response to various stimuli, including viral infection: in one study of menstruating women, around a quarter of those infected with SARS-CoV-2 experienced menstrual disruption.10
Biologically plausible mechanisms linking immune stimulation with menstrual changes include immunological influences on the hormones driving the menstrual cycle11 or effects mediated by immune cells in the lining of the uterus, which are involved in the cyclical build-up and breakdown of this tissue.12 Research exploring a possible association between covid-19 vaccines and menstrual changes may also help understand the mechanism.
Although reported changes to the menstrual cycle after vaccination are short lived, robust research into this possible adverse reaction remains critical to the overall success of the vaccination programme. Vaccine hesitancy among young women is largely driven by false claims that covid-19 vaccines could harm their chances of future pregnancy.13 Failing to thoroughly investigate reports of menstrual changes after vaccination is likely to fuel these fears. If a link between vaccination and menstrual changes is confirmed, this information will allow people to plan for potentially altered cycles. Clear and trusted information is particularly important for those who rely on being able to predict their menstrual cycles to either achieve or avoid pregnancy.
We are still awaiting definitive evidence, but in the interim how should clinicians counsel those who have experienced these effects? Initially, they should be encouraged to report any changes to periods or unexpected vaginal bleeding to the MHRA’s yellow card scheme. This will provide more complete data to facilitate research into any link and signal to patients that their concerns about vaccine safety are taken seriously, building trust. In terms of management, the Royal College of Obstetricians and Gynaecologists and the MHRA recommend that anyone reporting a change in periods persisting over several cycles, or new vaginal bleeding after the menopause, should be managed according to the usual clinical guidelines for these conditions.714
One important lesson is that the effects of medical interventions on menstruation should not be an afterthought in future research. Clinical trials provide the ideal setting in which to differentiate between menstrual changes caused by interventions from those that occur anyway, but participants are unlikely to report changes to periods unless specifically asked. Information about menstrual cycles and other vaginal bleeding should be actively solicited in future clinical trials, including trials of covid-19 vaccines.
- Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The author declares the following other interests: research funding from the Wellcome Trust and research charity Borne; payments to act as an external examiner for the University of Cambridge and the University of Leeds; and royalties received for my contribution to Immunology 9th edition (Elsevier). Further details of The BMJ policy on financial interests is here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf.
COVID-19 NEWS: Study to Investigate Impacts of COVID Vaccines on Menstruation
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Johns Hopkins Medicine’s Department of Gynecology and Obstetrics is one of five institutions selected by the National Institutes of Health (NIH) to conduct research to explore the potential impacts of COVID-19 vaccination on menstruation. The five one-year grants, totaling $1.67 million, are funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Office of Research on Women’s Health.
The NIH research grants were established after many women reported irregular menstrual periods and other menstrual changes after getting the COVID-19 vaccines.
“There may be several reasons why a woman might experience unscheduled menstrual bleeding, abnormal periods or bleeding that is heavier than usual,” says lead investigator Mostafa Borahay, M.D., Ph.D., associate professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine. “This research will help us better understand if there’s a real link between the COVID-19 vaccines and these menstrual changes, or if it’s something else, such as lifestyle changes or pandemic-related stress.”
Borahay and his team hypothesize that the immune response following vaccination may bring immune cells into the endometrium (uterus). This, say the researchers, may result in the menstrual irregularities that women are reporting.
“If there’s a relationship between the COVID-19 vaccines and the menstrual changes, we need to know how it happens,” says Borahay. “Therefore, we plan to examine the response of the endometrium to the COVID-19 vaccination at the biological level.”
Menstruation, or a period, is part of a woman’s monthly reproductive cycle. Each month, a woman’s uterus prepares for pregnancy and thickens its walls by increasing the levels of two hormones, estrogen and progesterone. But when pregnancy does not occur, the uterus sheds its lining as the blood and mucus making up the menstrual flow that leaves the body through the vagina during the period.
For the study, the researchers will collect data from different sources. “Through a collaboration with Clue, a period and ovulation tracking app, we will gather unidentifiable data from users about their menstrual cycle before and following COVID vaccination,” says Malak El Sabeh, M.D., a postdoctoral fellow working on the project in Borahay’s laboratory.
Borahay is available for interviews.
Flu, COVID and flurona: what we can and can’t expect this winter
Published: March 17, 2022 6.28am AEDT
- Ian Barr Deputy Director, WHO Collaborating Centre for Reference and Research on Influenza
Ian Barr owns shares in a vaccine producing company. His Centre receives funding from the Australian Government Department of Health as well as a number of commercial pharmaceutical companies.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence
When it comes to respiratory viruses, COVID has been our greatest concern over the past two winters. So you might feel some aspects of déjà vu as winter 2022 approaches in Australia.
But this year is different. With relaxed public health measures and the opening of international borders, we will likely see a rise in flu cases. This is on top of a predicted rise in COVID.
The potential double-whammy has prompted the federal government to announce A$2.1 billion to target these expected spikes. The funding has been earmarked for measures including vaccination, testing and measures to protect aged care.
Here’s what to expect and how to protect yourself ahead of winter.
Why can we expect more flu?
The main reason behind the expected rise in flu in 2022 is the opening of Australia’s international borders.
Tourists and returning residents can arrive without quarantining, provided they have the required COVID vaccinations and have had a COVID test beforehand. However, new arrivals don’t have to be tested for the flu virus, which they may inadvertently bring with them.
Flu, a little like COVID, can be spread by infected others before symptoms arise or even if symptoms don’t appear, something we regularly see in children. So once flu arrives, it will inevitably spread, regardless of whether we use masks, hand sanitiser or other measures.
In the past two years, for instance, we’ve seen large outbreaks of other common respiratory viruses. These include respiratory syncytial virus, human metapneumovirus, adenoviruses and rhinovirus. We’ve seen these even with strict COVID measures in Victoria, New South Wales and Queensland during 2020-2021.
How bad will it get?
It’s highly likely we’ll see COVID and influenza circulating at the same time this winter. But less certain is the more catastrophic predictions in the media of a so-called twindemic or syndemic.
COVID is more likely to persist and increase during the winter, and sometime during this period influenza will pop up. But we’re uncertain about the details.
Will flu be mild or more concerning in 2022? Will we see a rise in cases during the usual June-September period, peaking normally in August? The answers to these questions rely on history, the current situation and a good deal of speculation.
History tells us that after two seasons of low or no influenza circulating, we should expect a more severe season. That’s because the majority of people are not vaccinated against influenza each year and peoples’ natural immunity after infection will have waned.
However, current evidence argues against this. In the Northern Hemisphere, there have been low levels of flu circulating in most countries, with shorter outbreaks, compared with pre-pandemic years.
We’ve also seen a number of countries in the Southern Hemisphere – including South Africa, Brazil and Chile – having out-of-season flu outbreaks, during their 2021-2022 summer.
So this may mean the timing of Australia’s normal influenza season might be delayed until spring or even later in 2022.
Will I get ‘flurona’?
We may also see dual infections – when someone has COVID and influenza at the same time – sometimes dubbed “flurona”.
While this has occurred, the rates of dual infections globally have been low. Generally, under 1% of people with COVID also have influenza at the same time. Even with dual infections, people do not seem to be sicker than if they had COVID alone.
We’ll have a better idea of how many people will be infected with both viruses at once with the use of broader laboratory tests now available at many sites. These so called multiplex tests will detect a range of respiratory diseases, including COVID and flu, in a single test.
Fortunately, there is no way a new “hybrid virus” can emerge containing parts of SARS-CoV-2 (the virus that causes COVID) and the influenza virus in people with dual infections. These are distinct viruses that cannot combine.
How can I protect myself?
Despite the uncertainties around flu in Australia in 2022, the best way to protect yourself is to get your flu vaccine.
Everyone is susceptible to flu, no matter your age, health or lifestyle. However, some age groups and some people with underlying disease are likely to suffer more severe consequences if infected with influenza.
These include young children (especially those under two years old), people aged 65 and over, pregnant women, people with chronic lung and heart disease, those with asthma, diabetes and people who are obese.
Different flu vaccines target different age groups with different formulations. These vaccines have a proven safety record and usually only cause very mild reactions, such as soreness at the injection site, mild fever or headache. These may last for a 12-24 hours and are easily treated with paracetamol or similar medications.
Flu vaccines are free for children aged six months to under five years of age, people aged 65 or older, pregnant women and all Aboriginal and Torres Strait Islander people six months and older. People not eligible for free vaccines can still get them via their GP or some pharmacies.
This year you won’t have to schedule different visits for your influenza and COVID vaccinations. If needed, you can get them at the same time.
Influenza vaccines will be available from late March and will provide protection for at least 6-12 months. While these vaccines are not perfect they help prevent infection and the more serious consequences of the flu, such as hospitalisation and even death. So in April to May this year, as the cool days and nights return, think about booking in and getting your flu shot.
Getting an Invite to the Libido Party
A checklist of issues that may be interfering with your sexual drive, and what you can do to help.
By Jen Gunter
June 19, 2019
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Any hope for diminished (or nonexistent) sexual desire in a postmenopausal woman?
Yes! While some women do report a decreased libido with menopause there are some interventions to consider, depending on the cause.
Tell Me More
Libido is complex and depends on emotional, psychological and physical factors. It can also change over time. Seeking sexual satisfaction is also not the only reason someone might agree to or initiate a sexual encounter with their partner. For example, emotional intimacy, sharing mutual pleasure, bonding and many other reasons often become valid motivators for sex, especially in a long-term relationship.
At times libido may be spontaneous (meaning you actively seek sex from a partner), but libido may also be receptive (meaning a person initially feels sexually neutral, but after sexual stimulation of some kind, becomes aroused). Consider it this way: you can have a strong urge to go to a party and seek out festivities (a spontaneous libido) or need an invitation to want to go (receptive libido). Many people confuse receptive libido with a lack of libido.
Relationship issues are often the cause of a loss of interest in sex, especially for women who need emotional intimacy for their sexual response cycle. A family therapist, psychologist or sex therapist may be helping in identifying relationship issues and help devise a strategy for working on those concerns.
Pain with sexual activity should also be addressed. If sex is painful, losing interest is an expected consequence. In this case, a visit to a gynecologist or other provider familiar with the physical changes of menopause and managing pain with sexual activity is in order. While low estrogen from menopause is a common cause of pain with sex, there are many other possible causes.
Stress and lack of sleep can be part of a libido problem. If someone has a higher sex drive while on vacation, then situational factors and sources of stress should be considered.
Depression can affect libido, so screening and treatment is important if mental health is a concern.
Some blood pressure medications and antidepressants can negatively affect libido. If you take medications for these reasons ask your health care provider or pharmacist if they could have sexual side effects.
Things to Try
Learning about the mind-body connection libido-wise has been proven to be helpful for many women. I recommend the book “Better Sex Through Mindfulness: How Women Can Cultivate Desire,” by Dr. Lori Brotto. A sex therapist may also be helpful with mindfulness-based techniques.Editors’ Picks
For a menopausal woman who is distressed by her lack of libido and cannot identify any relationship issues, pain, depression or other medical causes, some providers may consider a trial of a pharmaceutical such as a low dose of transdermal testosterone or the oral medication flibanserin (Addyi). Neither therapy is approved by the Food and Drug Administration for postmenopausal women, so this is off-label use. There are some unresolved safety issues regarding heart disease and breast cancer with long-term use of testosterone for low libido for postmenopausal women, so it is important to ensure that the therapy is working sufficiently and the side effects are minimal to justify its continued use beyond a few months. Testosterone therapy should be monitored closely to avoid side effects, such as acne, facial hair growth and lowering of the voice.
There are no over-the-counter products — creams, oils or supplements — that are effective for low libido for menopausal women. These products are unregulated and so their ingredients and safety may not be accurate. Testosterone pellets are commonly advertised for improving libido, but the doses are too high to be safe, says the North American Menopause Society, so this therapy is not recommended.
Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.