Monthly Archives: April 2022
Uterine Fibroids Can Wreak Reproductive Havoc. What Are They?
Uterine Fibroids Can Wreak Reproductive Havoc. What Are They?
These benign tumors can affect women in their procreative prime, but they are more treatable than ever.
By Hilda Hutcherson
April 17, 2020
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This story was originally published on June 20, 2019 in NYT Parenting.
I was just a few months pregnant with my daughter when I had a routine ultrasound exam. I lay back, got gelled up and watched the screen, waiting for the image of my baby to appear. A layperson may not have noticed the white mass visible in the wall of my uterus, but I’m an obstetrician and it was unmistakable: a tumor the same size as my 3-month fetus. I recognized it as a fibroid, a benign mass, but I was concerned that, as my pregnancy progressed, it could cause problems. Fortunately, the fibroid didn’t grow, my pregnancy progressed normally and my daughter was born on her due date, healthy and thriving.
Mine was an ideal outcome, but that’s not always the case for expectant moms who are living with fibroids. While most pregnant women with fibroids experience no issues, some may experience difficulty conceiving, early pregnancy loss, preterm labor, low birth weight infants and increased risk of cesarean delivery. When one of my patients had experienced three pregnancy losses prior to our first visit, a complete workup revealed multiple fibroids as the most likely culprit. After successful surgery to remove more than 20 fibroids, she conceived and delivered a 7-pound baby boy by cesarean.
What are fibroids?
Fibroid tumors (also known as leiomyomas or myomas) are firm, white, round growths that are about the texture of solid rubber balls. Fibroids are described by their location in or on the uterus. They may grow on the inside (submucosal) or outside surfaces of the uterus (subserosal), within the musculature of the uterine wall (intramural) or on stalk-like growths on the outside of the uterus (pedunculated). Some are as small as baby peas; others may grow as large as a 9-month pregnancy. You may have only one or multiples of different sizes. Though fibroids are not cancerous, they can be a significant detriment to a woman’s reproductive health, causing problems such as anemia, infertility and pregnancy complications.
While we don’t really know what causes fibroids, we do know that they thrive on estrogen and progesterone, so they tend to be most problematic during the reproductive years when those hormones are at their highest levels. Once you hit menopause and your hormone levels decrease, fibroids don’t grow and usually start to shrink.
Fibroids are the most common benign tumor in women. They tend to increase in occurrence with age, affecting about 70 percent of white women and more than 80 percent of black women by age 50. Fibroids also tend to run in families: You’re twice as likely to have them if your mother or sisters do. The exact genetic link is still a mystery.
How will you know if you have them?
If your fibroids are small or on the inside of your uterus, and are not causing problems like heavy periods, you may never know you have them. But your ob-gyn can detect larger fibroids during a routine pelvic exam because they can make the uterus — which is typically about the size and shape of a pear — larger and bumpy. The most common fibroid symptom is heavy menstrual bleeding. Other symptoms can include pelvic pain or pressure, painful periods or pain during sex. Because the tumors may press against other organs, you might feel constipated or have the urge to urinate more frequently.
Who gets them?
As a gynecologist, I have diagnosed hundreds of women with fibroids. They’re a particular issue among black women, where they tend to grow faster, larger and more abundantly than they do in white women; and they can cause more severe symptoms, including intense period pain and heavy bleeding. Whereas most white women may not develop fibroids until their mid-30s, some black women start getting fibroids in their early- to mid-20s. That means they may be dealing with the tumors — and the fertility problems they can cause — throughout their prime childbearing years.
Will fibroids affect my fertility?
The majority of women who have fibroids won’t have infertility or pregnancy complications, but a small percentage of women may experience difficulty conceiving. Fibroids can block the fallopian tubes or cervical canal, making it more difficult to get pregnant. Tumors that grow inside the cavity of the uterus may interfere with implantation of a fertilized egg. Removing the fibroids can improve fertility and pregnancy outcomes. However, your doctor should be certain that the fibroids, and not other issues, are the cause of your infertility before going ahead with surgery.
Though most women are able to conceive despite having fibroids, tumors inside the uterus or within the walls of the uterus that are particularly large may sometimes cause problems with the pregnancy — such as miscarriage, preterm labor and delivery, or low birth weight — and lead to increased cesarean sections
What’s the best treatment?
Most women with fibroids never require treatment. If they’re not bothering you and aren’t interfering with other bodily functions, don’t bother them. They don’t need to be treated or removed, even if they’re fairly large. Your gynecologist or other health care provider will check them yearly during your routine exam. And obviously if you start having symptoms, that conversation may change. If you’re approaching menopause, you may be able to stick it out until your periods stop.
If you’re experiencing discomfort, pain or other symptoms, however, you may want to consider treatment. Years ago, the only option was hysterectomy — surgically removing the uterus. Fortunately, there are several more viable treatment options available today. Your choice will depend on your age; symptoms; and the location, number and size of the tumors, as well as your future pregnancy plans.
The first step is to get an ultrasonogram to confirm the presence of fibroids and estimate how many you have and where they are located on or in the uterus. Not every single fibroid will be detected, but the more significant ones will be mapped and measured. Some practitioners recommend an M.R.I. (magnetic resonance imaging) for a clearer picture.
Can medication help?
Heavy periods and cramping may be treated with birth control pills, non-steroidal anti-inflammatory drugs like ibuprofen or progestin-releasing I.U.D.s. These can make periods lighter and decrease menstrual cramping. These drugs may reduce your pain, but not the size of your fibroids.
Other types of drugs — such as gonadotropin-releasing hormone agonists — can shrink tumors by decreasing the hormone producing activity of your ovaries, lowering your estrogen levels. When fibroids are deprived of estrogen, their growth slows. But these medications should be used for only a limited amount of time because they cause menopausal symptoms like hot flashes and bone loss. They are generally used for several months to shrink fibroids before surgery.
New Developments in Cancer Research
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Progress in the field. In recent years, advancements in research have changed the way cancer is treated. Here are some recent updates:
Pancreatic cancer. Scientists are exploring whether the onset of diabetes may be an early warning sign of pancreatic cancer, which is on track to become the second leading cause of cancer-related deaths in the U.S. by 2040.
Chemotherapy. A quiet revolution is underway in the field of cancer treatment: A growing number of patients, especially those with breast and lung cancers, are being spared the dreaded treatment in favor of other options.
Prostate cancer. An experimental treatment that relies on radioactive molecules to seek out tumor cells prolonged life in men with aggressive forms of the disease — the second-leading cause of cancer death among American men.
Leukemia. After receiving a new treatment, called CAR T cell therapy, more than a decade ago, two patients with chronic lymphocytic leukemia saw the blood cancer vanish. Their cases offer hope for those with the disease, and create some new mysteries.
Esophageal cancer. Nivolumab, a drug that unleashes the immune system, was found to extend survival times in patients with the disease who took part in a large clinical trial. Esophageal cancer is the seventh most common cancer in the world.
What if drugs are off the table?
Consider other minimally invasive options. Uterine artery embolization, for instance, can block blood supply to the fibroids by injecting tiny plastic pellets into the vessels that supply blood to the fibroid. When fibroids are starved of adequate blood supply, they can’t grow and decrease in size. U.A.E. may also make periods lighter. Though it’s not foolproof: Up to 30 percent of women will need further surgery for symptoms after U.A.E. And it’s not first-line therapy for women who want to get pregnant.
Another alternative is an M.R.I.-guided focused ultrasound, which delivers high-intensity ultrasound waves to the fibroid through your abdomen. The ultrasound generates heat within the fibroid, causing cells to die and the fibroid to shrink. Because the waves are targeted, they won’t damage the rest of the uterus.
What are my surgical options?
You can remove the fibroids with a myomectomy, a type of surgery that leaves the uterus intact. This can be done laparoscopically — via a small incision using a camera — or with a more traditional surgery that involves a larger abdominal incision. If your fibroids are inside the uterine cavity, a third surgical option would be to insert a thin, lighted tube through the cervix so the fibroids can be shaved away.
All of these surgical methods preserve fertility, and studies suggest that women who have children after myomectomies are less likely to have their fibroids return than women who don’t. But removing the tumors isn’t a permanent fix. Studies have found a 40 to 50 percent risk that fibroids will grow back after five years. With that in mind, I usually recommend when possible that women delay surgery until a few months before they plan to conceive so, hopefully, the tumors won’t have time to grow back.
Another way to get rid of fibroids for good is to remove the entire uterus. In fact, hysterectomy — which involves making a small incision and using a laparoscope, or a large abdominal incision, and removing the uterus through it — is still the most common surgical treatment for fibroids: More than 200,000 women receive a hysterectomy for fibroids every year. Black women are twice as likely to undergo hysterectomy, and at an earlier age, than other women. While the surgery is a definitive treatment (fibroids have nowhere to grow), there are many potential side effects, including menopausal symptoms, pain, infection, urinary incontinence, prolapse of the vagina and sexual dysfunction. And, of course, this option is off the table if you want to deliver children.
Can fibroids be prevented?
Though the jury is still out, some studies suggest that your diet and lifestyle may affect your risk of fibroids. Obesity may increase fibroid risk by increasing your estrogen hormones. A few studies have suggested that diets rich in caffeine and alcohol may increase fibroid risk. Others have shown that adequate vitamin D levels, which are often low in black women, may be important in preventing fibroids. Recent studies suggest that psychosocial stress and inactive lifestyle may increase risk.
These links are not definitive, so don’t beat yourself up for your past diet and lifestyle if you’re diagnosed with fibroids. Of course, being at a healthy weight, eating lots of fruit and vegetables, avoiding high caffeine intake, exercising regularly and reducing stress may or may not decrease fibroids, but you’ll probably feel better.
Hilda Hutcherson is an obstetrician-gynecologist, senior associate dean and professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons.
People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame
People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame
Published: March 24, 2022 3.27am AEDT
Authors
- Anne-Marie Boylan Departmental Lecturer & Senior Research Fellow, University of Oxford
- Annalise Weckesser Senior Research Fellow, Medical Anthropology, Birmingham City University
- Sharon Dixon Researcher, Primary Care Health Sciences, University of Oxford
Disclosure statement
Anne-Marie Boylan has received funding from the National Institute of Health Research (NIHR).
Annalise Weckesser has received funding from NIHR and ESRC previously.
Sharon Dixon work on endometriosis in primary care was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project number: 403).
Partners
Birmingham City University and University of Oxford provide funding as members of The Conversation UK.
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Former Miss Ireland, Chelsea Farrell, recently shared the story of how she ended up in the emergency room in severe pain with a twisted ovarian cyst.
After over two-and-a-half years of symptoms, Farrell found out she had endometriosis, polycystic ovary syndrome (PCOS) and an ovarian cyst. She had suffered pain, irregular periods, bloating and pain during sex, but thought this was normal.
Farrell’s story isn’t unique. Many women face difficulties getting diagnoses, care and treatment for such conditions – with some women even reportedly waiting up to 12 years for help.
There are many complex reasons behind why women with these conditions wait so long for proper help and treatment. But part of it comes down to how women’s pain is often normalised and dismissed in healthcare settings – and even society more widely.
Working to make a difference in the world but struggling to save for a home. Trying to live sustainably while dealing with mental health issues. For those of us in our twenties and thirties, these are the kinds of problems we deal with every day. This article is part of Quarter Life, a series that explores those issues and comes up with solutions.
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In 2020, an Oxford school caused controversy after suggesting girls should not miss school because of period pain. It reportedly stated: “Learning to deal with a monthly inconvenience is all part of being a woman.”
Not only does this show a lack of understanding of how debilitating menstrual pain can be, but also how girls are taught early on to endure pain rather than to seek help or medical advice.
This could also mean girls living with possible signs of endometriosis or PCOS won’t seek the help that they need. In fact, many women with PCOS or endometriosis report they felt expected not to to complain and “get on with it”, and to accept that “it’s a woman’s lot to suffer.”
This attitude means that women are often not involved in their own care and that their complaints are often dismissed as “women’s problems”. This “arrogant culture” of not taking women’s concerns seriously has even led to decades of medical scandals, avoidable patient harm, and needless suffering.
Unnecessary wait
For the last decade, the average wait for an endometriosis diagnosis in the UK is eight years. Patients often have up to ten doctor visits before being diagnosed.
For PCOS, it can often take more than two years and appointments with around three doctors for a diagnosis. Both endometriosis and PCOS are complex conditions with symptoms that may vary widely and also resemble other conditions. So, the diagnostic process is also complex, which explains to some extent why diagnosis is slow.
But complexity around diagnosis is not just about symptoms. The UK government’s recent Women’s Health Survey captured how women continue to be dismissed and ignored when seeking care. It can be difficult for them to put their pain into words and they report not always being believed.
Having their pain dismissed leads many women on a quest for “credibility” in the hopes of being believed that symptoms are not just “in their head”. But when your experiences aren’t believed by healthcare professionals, it can lead to lower self esteem and even depression.
Gender health gap
The struggles that many women experience when trying to receive a diagnosis for these types of conditions is part of a larger problem when it comes to women’s health. Historically, women have experienced inequality in the kind of healthcare and treatment they have received – which is known as the gender health gap.
The gender health gap may explain why women are more likely to suffer poorer outcomes when treated by male doctors. It may also be why women are more likely to die from heart attacks, as their symptoms can be different from men’s, whose symptoms still dominate medical textbooks and messaging around first aid.
Women’s pain is treated less aggressively than men’s even when they rate it more severely, it lasts longer or occurs more often.
The gender health gap is even wider for black women living in the US and UK. Black women are less likely to be diagnosed with endometriosis than white women. They’re also more likely to develop uterine fibroids and are significantly more likely to have debilitating symptoms because of them.
Black women may also be more disproportionately affected by PCOS. Though the reasons for this aren’t fully understood, it might partly be due to poorer access to healthcare.
While problems with women’s health are increasingly being recognised, repeated calls in the past to raise awareness and education for girls, women, and healthcare professionals haven’t led to much-needed change. It’s essential that better, evidence-based resources are developed for both women and health professionals to ensure that every woman – no matter her health needs or experiences – can receive the right care.
But it’s simplistic to assume that the difficulties women face in accessing equitable healthcare and the right diagnosis will be solved by more information alone.
We must also address the larger societal issues of stigmatising and de-prioritising women’s health, the inadequate funding for women’s health research and the implicit gender and racial biases that underpin current health inequalities.
It’s unlikely that significant changes in the way women’s healthcare is delivered will happen anytime soon. So for now, it will be important that women continue to advocate for their own health.
If you suspect you may have endometriosis or PCOS, continue to seek help. Consider keeping track of your pain and symptoms so you can discuss them with your GP. Remember, pain is not something you have to put up with.
Remind me again, why is salt bad for you?
Remind me again, why is salt bad for you?
Published: April 7, 2022 12.31pm AEST
Author
- Evangeline Mantzioris Program Director of Nutrition and Food Sciences, University of South Australia
Disclosure statement
Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.
University of South Australia provides funding as a member of The Conversation AU.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.
Despite most of us knowing we should cut down on salt, Australians consume on average almost twice the recommended daily maximum per day.
Salt has been used in food preservation for centuries, and idioms like “worth your weight in salt” indicate how valuable it was for preserving food to ensure survival. Salt draws moisture out of foods, which limits bacterial growth that would otherwise spoil food and cause gastrointestinal illnesses. Today, salt is still added as a preservative, but it also improves the taste of foods.
Salt is a chemical compound made of sodium and chloride, and this is the main form in which we consume it in our diet. Of these two elements, it’s the sodium we need to worry about.
Read more: Is salt good for you after all? The evidence says no
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So what does sodium do in our bodies?
The major concern of consuming too much sodium is the well-established link to the increased risk of high blood pressure (or hypertension). High blood pressure is in turn a risk factor for heart disease and stroke, a major cause of severe illness and death in Australia. High blood pressure is also a cause of kidney disease.
The exact processes that lead to high blood pressure from eating large amounts of sodium are not fully understood. However, we do know it’s due to physiological changes that occur in the body to tightly control the body’s fluid and sodium levels. This involves changes in how the kidneys, heart, nervous system and fluid-regulating hormones respond to increasing sodium levels in our body.
Maintaining tight control on sodium levels is necessary because sodium affects the membranes of all the individual cells in your body. Healthy membranes allow for the movement of:
- nutrients in and out of the cells
- signals through the nervous system (for example, messages from the brain to other parts of your body).
Dietary salt is needed for these processes. However, most of us consume much, much more than we need.
When we eat too much salt, this increases sodium levels in the blood. The body responds by drawing more fluid into the blood to keep the sodium concentration at the right level. However, by increasing the fluid volume, the pressure against the blood vessel walls is increased, leading to high blood pressure.
High blood pressure makes the heart work harder, which can lead to disease of the heart and blood vessels, including heart attack and heart failure.
While there is some controversy around the effect of salt on blood pressure, most of the literature indicates there is a progressive association, which means the more sodium you consume, the more likely you are to die prematurely.
Read more: Salt overload – it’s time to get tough on the food industry
What to watch out for
Certain groups of people are more affected by high-salt diets than others. These people are referred to as “salt-sensitive”, and are more likely to get high blood pressure from salt consumption.
Those most at risk include older people, those who already have high blood pressure, people of African-American background, those who have chronic kidney disease, those with a history of pre-eclampsia (high blood pressure during pregnancy), and those who had a low birth weight.
It is important to be aware of your blood pressure, so next time you visit your doctor make sure you get it checked. Your blood pressure is given as two figures: highest (systolic) over lowest (diastolic). Systolic is the pressure in the artery as the heart contracts and pushes the blood through your body. The diastolic pressure in the artery is when the heart is relaxing and being filled with blood.
Read more: There’s more hidden salt in your diet than you think
Optimal blood pressure is below 120/80. Blood pressure is considered high if the reading is over 140/90. If you have other risk factors for heart disease, diabetes or kidney disease, a lower target may be set by your doctor.
How to reduce salt intake
Reducing salt in your diet is a good strategy to reduce your blood pressure, and avoiding processed and ultra-processed foods, which is where about 75% of our daily salt intake comes from, is the first step.
Increasing your intake of fruit and vegetables to at least seven serves per day may also be effective in reducing your blood pressure, as they contain potassium, which helps our blood vessels relax.
Increasing physical activity, stopping smoking, maintaining a healthy weight and limiting your alcohol intake will also help to maintain a healthy blood pressure. Blood pressure reducing medications are also available if blood pressure can not be reduced initially by lifestyle changes.
Read more: What we may think are the healthiest bread and wrap options actually have the most salt
Fifteen health benefits of pomegranate juice
Read Dr Tina Peer’s Story on “The Latte Lounge”web-site, for how Pomegranate Juice (and Beetroot Juice” can benefit some women, and men worried about hardening of the arteries. Tina’s story also has lessons for women as to how to deal with specialists when given a diagnosis of breast cancer. Hint: always ask for absolute numbers – not percentages. You may be told going onto chemotherapy can reduce your chances of a recurrence by 50%. Who wouldn’t jump at those odds. But if you were told that the chance of a recurrence drops from 2 women in a hundred over 5 years, to 1 women in 5 years for example,(50%), makes the decision not so clear cut.
Fifteen health benefits of pomegranate juice
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Fresh juice doesn’t have to be green or full of spinach to be healthy. Pomegranate juice contains more than 100 phytochemicals. The pomegranate fruit has been used for thousands of years as medicine.
Today, pomegranate juice is being studied for its many health benefits. It may help with cancer prevention, immune support, and fertility.
Benefits of Pomegranate
Here are some of the potential benefits of pomegranate.
1. Antioxidants
Pomegranates have been eaten throughout history for their health benefits. Nowadays, the juice of this fruit is a popular part of healthy diets.
Pomegranate seeds get their vibrant red hue from polyphenols. These chemicals are powerful antioxidants.
Pomegranate juice contains higher levels of antioxidants than most other fruit juices. It also has three times more antioxidants than red wine and green tea. The antioxidants in pomegranate juice can help remove free radicals, protect cells from damage, and reduce inflammation.
2. Vitamin C
The juice of a single pomegranate has more than 40 percent of your daily requirement of vitamin C. Vitamin C can be broken down when pasteurized, so opt for homemade or fresh pomegranate juice to get the most of the nutrient.
3. Cancer prevention
Pomegranate juice recently made a splash when researchers found that it may help stop the growth of prostate cancer cells. Despite multiple studies on the effects of the juice on prostate cancer, results are still preliminary.
While there haven’t been long-term studies with humans that prove that pomegranate juice prevents cancer or reduces the risk, adding it to your diet certainly can’t hurt. There have been encouraging results in studies so far, and bigger studies are now being doneTrusted Source.
4. Alzheimer’s disease protection
The antioxidants in the juice and their high concentration are believed to stall the progress of Alzheimer disease and protect memory.
5. Digestion
Pomegranate juice can reduce inflammation in the gut and improve digestion. It may be beneficial for people with Crohn’s disease, ulcerative colitis, and other inflammatory bowel diseases.
While there are conflicting beliefs and research on whether pomegranate juice helps or worsens diarrhea, most doctors recommend avoiding it until you are feeling better and your symptoms have subsided.
6. Anti-inflammatory
Pomegranate juice is a powerful anti-inflammatory because of its high concentration of antioxidants. It can help reduce inflammation throughout the body and prevent oxidative stress and damage.
7. Arthritis
Flavonols in pomegranate juice may help block the inflammation that contributes to osteoarthritis and cartilage damage. The juice is currently being studiedTrusted Source for its potential effects on osteoporosis, rheumatoid arthritis, and other types of arthritis and joint inflammation.
8. Heart disease
Pomegranate juice is in the running as the most heart-healthy juice. It appears to protect the heart and arteries.
Small studiesTrusted Source have shown that the juice improves blood flow and keeps the arteries from becoming stiff and thick. It may also slow the growth of plaque and buildup of cholesterol in the arteries. But pomegranate may react negatively with blood pressure and cholesterol medications like statins.
Be sure to talk with your doctor before indulging in the juice or taking a pomegranate extract supplement.
9. Blood pressure
Drinking pomegranate juice daily may also help lower systolic blood pressure. A comprehensive review of randomized controlled trials stated that it would be beneficial for heart health to include pomegranate juice daily.
10. Antiviral
Between the vitamin C and other immune-boosting nutrients like vitamin E, pomegranate juice can prevent illness and fight off infection. Pomegranates have also been shown to be antibacterial and antiviral in lab tests. They are being studied for their effects on common infections and viruses.
11. Vitamin-rich
In addition to vitamin C and vitamin E, pomegranate juice is a good source of folate, potassium, and vitamin K.
Whether you decide to add pomegranate to your daily diet or just sip on it every now and then, check the label to ensure that it is 100 percent pure pomegranate juice, without added sugar. Or, juice it fresh.
12. Memory
Drinking 8 ounces of pomegranate juice a daily may improve learning and memory, according to a recent study.
13. Sexual performance and fertility
Pomegranate juice’s concentration of antioxidants and ability to impact oxidative stress make it a potential fertility aid. Oxidative stress has been shown to cause sperm dysfunction and decrease fertility in women.
The juice has also been shown to help reduce oxidative stress in the placenta. But researchers don’t yet know the exact benefits this may provide. Drinking pomegranate juice can also increase testosterone levels in men and women, one of the main hormones behind sex drive.
14. Endurance and sports performance
Move over, tart cherry and beet juice. Pomegranate juice may be the new sport performance enhancer. The juice may help reduce soreness and improve strength recovery. It also decreases oxidative damage caused by exercise.
15. Diabetes
Pomegranate was traditionally used as a remedy for diabetes in the Middle East and India. While much is still unknown about the effects of pomegranate on diabetes, it may help decrease insulin resistance and lower blood sugar.
Bottom line
Green juice isn’t the only healthy option out there. Adding pomegranate juice to your diet may reduce your risk for chronic disease and inflammation. It’s also a great way to get the fruit’s nutrients and a boost of antioxidants.
There are various brands of pomegranate juice to purchase online. It is a good idea to compare different products to choose the most beneficial one.
It’s best to check with your doctor before drinking pomegranate juice every day, to make sure it won’t interfere with any of your medications. Also, diabetics should check blood sugars daily if choosing pomegranate juice over whole pomegranates to ensure blood sugars remain optimal.
Last medically reviewed on January 21, 2019
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https://www.researchgate.net/publication/228966344_Pomegranate_Punica_granatum_L_A_medicinal_plant_with_myriad_biologic_properties_A_short_review - Pomegranate. (2016, June 21).
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http://www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html - Sahebkar, A., Ferri, C., Giorgini, P., Bo, S., Nachtigal, P., Grassi, D. (2017). Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Pharmacological Research. 115, 149-161
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Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it
Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it
Published: April 6, 2022 12.54pm AEST
Author
- Natasha Yates Assistant Professor, General Practice, Bond University
Disclosure statement
Natasha Yates is affiliated with the RACGP
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Bond University provides funding as a member of The Conversation AU.
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People are often surprised by how fatigued they are during a COVID infection.
Fatigue is more than being worn out or sleepy. It’s an excessive tiredness that persists despite resting or good sleep. It’s likely a result of our body’s strong immune response to the virus.
But in some people the fatigue drags on even when the infection is gone. This can be debilitating and frustrating. Simply resting more makes no difference.
Here’s what we know about post-COVID fatigue, and what can help.
Fatigue or tiredness? What’s the difference?
The term fatigue can mean different things to different people. Some people mean their muscles are easily weakened. Walking to the mailbox feels like they have run a marathon. Others describe a generalised exhaustion, whether they are moving or not. People can experience physical, mental or emotional fatigue, or any combination of these.
The difference between tiredness and fatigue is this: tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.
Read more: Still coughing after COVID? Here’s why it happens and what to do about it
How big a problem is this?
Because there is no agreed definition of post-COVID fatigue, it is impossible to give exact numbers of how many people experience it.
Estimates vary considerably worldwide. One review of 21 studies found 13-33% of people were fatigued 16-20 weeks after their symptoms started. This is a worryingly widespread problem.
When should I see my GP?
There are many potential causes of fatigue. Even before the pandemic, fatigue was one of the most common reasons to see a GP.
Most serious causes can be ruled out when your GP asks about your symptoms and examines you. Sometimes your GP will investigate further, perhaps by ordering blood tests.
Symptoms that should raise particular concern include fevers, unexplained weight loss, unusual bleeding or bruising, pain (anywhere) that wakes you from sleep, or drenching night sweats.
If your fatigue is getting worse rather than better, or you cannot care for yourself properly, you really should seek medical care.
Is it like long COVID?
Early in the pandemic, we realised some patients had a cluster of debilitating symptoms that dragged on for months, which we now call long COVID.
Some 85% of long COVID patients experience fatigue, making it one of the most common long COVID symptoms.
However, people with long COVID have a range of other symptoms, such as “brain fog”, headaches and muscle aches. Patients with long COVID therefore experience more than fatigue, and sometimes don’t have fatigue at all.
Read more: Social media, activism, trucker caps: the fascinating story behind long COVID
Is this like chronic fatigue syndrome?
We knew about chronic fatigue syndrome, otherwise known as myalgic encephalomyelitis, well before COVID.
This often develops after a viral infection (for instance after infection with Epstein-Barr virus). So, understandably, there has been concern around the coronavirus potentially triggering chronic fatigue syndrome.
Read more: Explainer: what is chronic fatigue syndrome?
There are striking similarities between chronic fatigue syndrome and long COVID. Both involve debilitating fatigue, brain fog and/or muscle aches.
But at this stage, researchers are still untangling any link between post-COVID fatigue, long COVID and chronic fatigue syndrome.
For now, we know many people will have post-COVID fatigue but thankfully do not go on to develop long COVID or chronic fatigue syndrome.
What helps me manage my fatigue?
Expect you or a loved one may develop post-COVID fatigue, regardless of how unwell you or they were during the actual infection.
Vaccines help reduce the risk of post-COVID fatigue by lowering the chance of catching COVID in the first place. Vaccinated people who do catch COVID are less likely to report fatigue and are less likely to develop long COVID.
However, vaccination is not 100% protective and there are plenty of fully vaccinated people who go on to develop longer term fatigue.
The evidence for what helps you recover from post-COVID fatigue is in its infancy. However, a few things do help:
1. pace yourself: adjust the return to normal activities to your energy levels. Choose your priorities and focus on what you can do rather than what you can’t
2. return to exercise gradually: a gradual return to exercise may help your recovery, but you may need some support about how to manage or avoid fatigue afterwards. Some therapists – occupational therapists, physiotherapists and exercise physiologists – specialise in this. So ask your GP for a recommendation
3. prioritise sleep: rather than feeling guilty about sleeping so much, remind yourself that while you sleep, your body conserves energy and heals. Disrupted sleep patterns are an unfortunate COVID symptom. Having a strict bedtime, while also resting when you feel tired during the day, is important
4. eat a range of nutritious foods: loss of smell, taste and appetite from COVID can make this tricky. However, try to view food as a way of fuelling your body with both energy and the micronutrients it needs to heal. Be careful not to spend a fortune on unproven “remedies” that often look good in small studies, but more robust research finds make little difference
5. monitor your fatigue: keep a diary to monitor your fatigue, and look for a gradual improvement. You will have good days and bad days, but overall there should be a slow trajectory towards recovery. If you are going backwards, get input from a health professional, such as your GP.
Perimenopausal and taking HRT
24 Mar 2022
Perimenopausal and taking HRT
Oh My God- I am NOT losing my mind, I am just losing my oestrogen.
What’s wrong with me?
I can’t figure it out. I go to sleep and wake up tired. I’m a mess emotionally. My husband just gave me a framed photo of our dinner menu from our wedding anniversary and I burst into tears. I then turned around and bit his head off because he was breathing out of the wrong nostril. Later on, I was swamped by a feeling of crushing worry, more than anxiety, my mind was racing and then it wasn’t racing, I was just under a cloud, as if all my emotions were fading into the background.
Luckily, I had already looked into what I was feeling. I happened upon Dr Louise Newson’s Instagram page which led me to her website, to the NICE guidelines on perimenopause and I thought…
Oh My God- I am NOT losing my mind, I am just losing my oestrogen.
What a relief.
I was prescribed antidepressants instead of HRT
So I went to my doctor. She listened to me recall my symptoms, and then she prescribed me antidepressants.
“Oh no,” I said, “I’m not depressed. I think I am in perimenopause and that HRT might be a good option.”
‘Oh’- she said- “no- I can’t prescribe that because of the increased risk of breast cancer.”
“Oh”- I said- “I researched that and in fact it was a 2008 study, now debunked and incomplete, and there is no association between breast cancer and topical oestrogen and micronized progestin.” She just shook her head.
I knew it was Oestrogen I needed not antidepressants
Now, not that long ago I would have walked out of the office and felt defeated. Not that day. I asked for a referral to my ObGyn whom I’d talked to about my symptoms in a prior meeting. I knew he was open to discussing further.
Within a few minutes of chatting to him, he thought I would be a good candidate for oestrogen. I cannot describe the relief that I was being listened to. Sometimes that’s part of the puzzle too, being cared for, and having my concerns validated and alleviated, that my symptoms were not a sign of mental instability.
And guess what?
Within a couple of days my symptoms were gone, and I was back!
I know HRT isn’t a one size fits all, that women’s health is multi faceted, and that we can do a much better job supporting women in midlife, rather than dismissing them. I was lucky that my ObGyn listened and cared; I just don’t think women should have to be lucky to get the care they need and deserve.
Written by: Catherine Brennan, Toronto
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How often do young women die of heart attacks and what can you do to improve your heart health?
How often do young women die of heart attacks and what can you do to improve your heart health?
Published: March 16, 2022 3.57pm AEDT
Authors
- Sally Inglis Professor, Heart Foundation Future Leader Fellow, IMPACCT, Faculty of Health, University of Technology Sydney
- Clara Chow Cardiologist at Westmead Hospital; Director of the Westmead Applied Research Centre, University of Sydney
- Patricia Davidson Vice Chancellor, University of Wollongong
Disclosure statement
Sally Inglis currently receives funding from the Heart Foundation in the form of a Future Leader Fellowship. Sally is Chair of the Cardiovascular Nursing Council of the Cardiac Society of Australia and New Zealand (CSANZ) and Deputy Chair of the NSW Cardiovascular Research Network.
Clara Chow has an NHMRC Investigator grant. She is President of the Cardiac Society Australia and New Zealand, a board member of the Western Sydney Local Health District, and on a steering group of the National Health Foundation, which is writing guidelines on cardiovascular risk assessment.
Patricia Davidson has received funding from the ARC, NHMRC and National Institutes of Health in the United States.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.The news of 52-year-old Senator Kimberley Kitching’s death from a suspected heart attack is a tragic loss that has shocked many women.
At a time when the community was grappling with the sudden death of Shane Warne – and we asked the men in our lives to pay attention to their heart health – Kitching’s sudden death served as a stark warning of the risk of heart disease to women.
These risks are often overlooked, particularly in younger women, and the warning signs may differ from those typically seen in men.
What’s the risk of having a heart attack?
Heart disease is a leading cause of death and disability in both women and men in Australia.
Get your news from people who know what they’re talking about.
The risk of an acute event (including heart attack) increases with age for both men and women: from five per 100,000 for women aged 25–34 (13 per 100,000 for men) to 2,100 per 100,000 for women aged 85 and over (2,900 per 100,000 for men).
Around 14% of women aged 45-74 years are at high risk of a heart attack over the following five years.
Across all age groups, 20 Australian women die from heart disease each day.
How do women experience heart attacks?
Women’s experience of a heart attack can be different to men’s – they are less likely to have chest pain.
Women are more likely to suffer shortness of breath and have pain between the shoulder blades. They’re also likely to have nausea or vomiting.
We often hear of women delaying calling an ambulance or waiting to see if the discomfort eases before they seek care.
Women are also less likely to receive timely treatment.
Read more: Women who have heart attacks receive poorer care than men
Effective treatment is available in hospital. But delaying treatment may reduce the benefit of therapies and lead to poorer outcomes.
How to reduce your risk of heart attacks
Taking steps to reduce the risk of heart disease and a heart attack is important for all women. Here are four things you can do today:
1. Get your heart health checked
Australians aged 45 years and older and Indigenous Australians aged 30 years and older can have a Medicare-funded heart health check with a GP.
During this appointment, your GP will calculate your risk of having a heart attack in the next five years. This will be done using information from your medical history, family history, lifestyle factors, and measurements such as your blood pressure and a blood test.
Tests may also include an ECG (electrocardiogram) and CT calcium score. An ECG looks at your heart rhythm, while a CT calcium score measures the amount of calcium inside the walls of your heart’s arteries. This can indicate a build-up of plaque (a blockage) inside the blood vessel that could increase your risk of a heart attack.
Based on your risk score, the GP will be able to provide treatment advice to reduce your risk of a heart attack. If the risk score is high, they may recommend specific medicines. At lower risk scores, lifestyle modifications – such as changes to diet, exercise and quitting smoking – may be recommended as the initial approach.
Read more: Women have heart attacks too, but their symptoms are often dismissed as something else
2. Quit smoking
Smoking substantially increases the risk of heart disease. It narrows and clogs the blood vessels, reducing blood supply and oxygen throughout the body. Smoking also makes the blood vessels stiff and unable to stretch.
People who smoke are four times more likely to die of heart disease and three times more likely to die of a heart attack.
Stopping smoking leads to better overall health at any age, and especially heart health. Support to stop smoking is available through Quit Line – it’s never too late to stop.
3. Get moving
Exercise has many physical and mental health benefits, including lowering blood pressure and cholesterol.
If you have heart disease, physical activity can help you manage the condition, lower the risk of type 2 diabetes and keep your weight in check. Achieving a healthy weight also reduces your risk for heart disease.
Walking is a great way to start exercising and can be done with a friend to provide peer support, or within community walking groups.
4. Swap unhealthy food
Swap out less healthy food for healthier options, including vegetables and fruits, and cut down on salt and soft drinks.
Making changes can be challenging, but start with a few achievable changes and low-cost, healthy recipes.
Improving access to care
Access to preventative care, specialist support and rehabilitation following a heart attack is critical to reducing death and disability of heart disease.
More can be done to improve access to care, especially in priority groups such as women from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander women, and women living in rural and remote Australia.
Better access to care requires ensuring primary care workforce capacity, especially in rural and remote areas, as well as funding and policies to increase access to primary care nurses, nurse practitioners and cardiac rehabilitation services.
Telehealth is a valuable tool to improve access to GPs and specialist cardiac services, especially in rural and remote areas.
All Australians have had a wake-up call to be aware of their heart health. Reducing your risk of heart disease begins with making a GP appointment for a heart health check to get personalised support to live a healthy life
5 common drugs you should consider Stopping
5 common drugs you should consider deprescribing
PPIs include Nexium, Somac, Losec and others.
John Murphy|February 11, 2020
Doctors learn quite a bit about prescribing medications but not quite as much about deprescribing them. Consequently, many patients wind up on numerous medications, some of which they may no longer need.
“Nearly one-half of older adults take five or more medications, and as many as one in five of these prescriptions is potentially inappropriate,” wrote two pharmacists in an editorial in American Family Physician.
“Polypharmacy is a clinical challenge because the health care system is geared toward starting medications, not reducing or stopping them, and guidelines typically include recommendations for initiating medications, but not stopping them,” they wrote.
Just as there is an art and science to prescribing medications, there’s a complementary art and science to deprescribing them. With that in mind, here are five medications that doctors may consider deprescribing—with an eye toward individualized therapy, of course.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are widely prescribed, rarely deprescribed, and commonly purchased over the counter. They’re frequently used without medical indication and for much longer than needed. The general indication is for only 2 weeks, not long term. Though PPIs have traditionally been considered safe, they’ve since been linked to serious adverse events—including cardiovascular disease (CVD), pneumonia, osteoporotic fractures, Clostridioides difficile infections, acute kidney injury, chronic kidney disease, dementia, upper gastrointestinal cancer, and death.
“Given the millions of people who take PPIs regularly, this translates into thousands of excess deaths every year,” said nephrologist Ziyad Al-Aly, MD, Clinical Epidemiology Center, Department of Veterans Affairs St. Louis Health Care System, St Louis, MO, whose research team linked PPIs to greater mortality.
“Our study suggests the need to avoid PPIs when not medically necessary,” he added. “For those who have a medical need, PPI use should be limited to the lowest effective dose and shortest duration possible.”
Statins
Statins are among the most commonly prescribed drugs, with more than 35 million Americans taking them. An estimated two-thirds of these patients take statins for the primary prevention of CVD.
Do all these millions of people really need to take this medicine? It’s a hotly debated topic.
Last year, the authors of an analysis of systematic reviews investigated the relationship between taking statins and future risk of CVD. They concluded that there was limited evidence on the effectiveness of using statins for the primary prevention of CVD.
In a related study, the same researchers found that the number needed to treat to prevent one major vascular event was 400 for low-risk patients compared with ≤ 25 for very high-risk patients.
“One would have to question whether some patients, who may achieve very small reductions in risk of [CVD] by taking statins, would agree to take this medication were they fully informed,” said the lead author of the studies.
When deciding whether to prescribe statins, clinicians should consider individual baseline risk, absolute risk reduction, and whether the risk reduction justifies the potential harms of taking a daily medicine for life, the authors recommended.
Antibiotics
Just about all doctors would agree that antibiotic overprescribing is a problem, and yet the problem continues. Of the estimated 154 million antibiotic prescriptions written each year in US outpatient settings, at least 30% are unnecessary, according to the CDC. Likewise, 20% to 50% of antibiotics prescribed in US acute care hospitals are unnecessary or inappropriate.
According to the FDA, more than 70% of the bacteria responsible for the 2 million infections acquired in US hospitals each year are resistant to at least one commonly used antibiotic.
Beyond antibiotic resistance, the risks of antibiotic overuse or overprescribing include increases in disease severity, disease length, health complications, adverse effects, mortality risk, healthcare costs, re-hospitalization, and medical treatment for health problems that might have otherwise resolved on their own.
Antimuscarinic drugs for overactive bladder
Antimuscarinic medications for overactive bladder are not especially effective. They also have a high rate of adverse effects. As a consequence of these two factors, patients commonly discontinue these drugs (or want to discontinue them).
“In line with published reports, a major reason for patients not restarting treatment was that they experienced no difference in symptoms on or off treatment,” wrote pharmacist Seema Gadhia in The Pharmaceutical Journal.
In terms of efficacy, antimuscarinic agents restored continence in only about 10% of patients, researchers reported in a systematic review published in Annals of Internal Medicine. For example, in pooled analyses, continence was restored in 8.5% of patients taking tolterodine (Detrol), 10.7% taking solifenacin (Vesicare), 11.4% taking oxybutynin (Ditropan), 11.4% taking trospium (Sanctura), and 13.0% taking fesoterodine (Toviaz).
These relatively low efficacy rates compel an uncommonly high number of patients to discontinue antimuscarinics.
Antimuscarinics also have a high risk of adverse side effects that limit their tolerability. The most common adverse effects include dry mouth, constipation, blurred vision, somnolence, and dizziness. Long-term use of antimuscarinics has also been associated with an increased risk of cognitive impairment and mortality in older adults.
Benzodiazepines
Benzodiazepines and related “Z” drugs—such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)—are sedative-hypnotics commonly prescribed to treat anxietyn;, mood disorders, depression, and insomnia, as well as seizures. In fact, they’re very commonly prescribed—over 5% of US adults are on benzodiazepines, according to one estimate. (A more recent calculation places their use at over 12%.) And benzodiazepine use is growing, with prescription rates nearly doubling between 2003 and 2015—a pattern similar to that of opioids.
Misuse of benzodiazepines is also common, with 5.3 million Americans taking benzodiazepines in a way not prescribed by their physicians. Misuse includes taking the drugs without a prescription, taking higher doses than prescribed, and taking them more frequently or for longer than prescribed. As to the latter, benzodiazepines are intended to be used for fewer than 14 days but chronic use (more than 120 days) is common. This is particularly true among older adult benzodiazepine users (aged 60-80 years), 31.4% of whom were found to be taking the drug long term. Notably, most prescriptions for benzodiazepines used long term were written by non-psychiatrist prescribers.
Dr Colin Holloway 
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