Monthly Archives: May 2022

Ovarian cancer is not a silent killer – recognizing its symptoms could help reduce misdiagnosis and late detection

Ovarian cancer is not a silent killer – recognizing its symptoms could help reduce misdiagnosis and late detection

Published: April 25, 2022 10.13pm AEST

Author

  1. Barbara Goff Professor of Obstetrics and Gynecology, University of Washington

Disclosure statement

Barbara Goff receives funding from National Institutes of Health, TEAL foundation. Ovarian Cancer Research Foundation and Marsha Rivkin Foundation

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Ovarian cancer is the most deadly of gynecologic tumors. Fewer than 40% of those diagnosed with ovarian cancer are cured, and approximately 12,810 people in the U.S. die from the disease every year.

For the past 25 years, scientists have tried to identify a screening test to detect ovarian cancer in its earliest stages, when the chance of cure is high. Unfortunately, multiple clinical trials with hundreds of thousands of participants have failed to identify an effective way to screen for ovarian cancer. In fact, the U.S. Preventive Services Task Force gave ovarian cancer screening a grade of D in 2018, meaning it recommends against periodic screening because it doesn’t improve survival and can prove harmful to patients.

Because no effective screening test currently exists, 70% of people with ovarian cancer are diagnosed at advanced stages, when chances of cure are poor. Around 60% to 90% of people with stage one or two cancer that stays around the ovaries and pelvis are disease-free five years after diagnosis, compared with only 10% to 40% of those with stage three or four cancer that has spread through the abdomen and beyond.

But even those with advanced disease have a higher chance of being cured if complete surgical removal is still possible. This makes early diagnosis all the more important for overall survival.

Without screening tests, many physicians wrongly assume that early diagnosis for ovarian cancer isn’t possible. As a gynecologic oncologist who treats hundreds of ovarian cancer patients each year, I was frustrated by these late diagnoses, and wondered if better recognition of its symptoms could help clinicians and patients identify ovarian cancer earlier. Ovarian cancer is often misdiagnosed.

Detectable symptoms

Ovarian cancer has historically been called a “silent killer,” because clinicians thought its symptoms were undetectable. Patients were often diagnosed so late that doctors thought nothing could be done.

But there have been many studies over the past 20 years demonstrating that ovarian cancer does have early warning signs. My colleagues and I conducted one of the earliest studies in 2000. Our survey of 1,700 people with ovarian cancer found that 95% of patients reported noticeable symptoms three to 12 months before diagnosis. The most common symptoms were pain in their pelvis and abdomen, increased frequency and urge to urinate, difficulty eating or feeling full quickly, and bloating or abdominal distension.

Importantly, people with both advanced- and early-stage disease reported similar types of symptoms. Subsequent studies from multiple researchers further confirm that patients with even early-stage ovarian cancer experience frequent symptoms.

We also found that providers often misdiagnosed ovarian cancer as another condition. When we asked patients what their doctors told them was the cause of their symptoms, 15% had their symptoms attributed to irritable bowel disease, 12% to stress, 9% to gastritis, 6% to constipation, 6% to depression and 4% to some other cause. Thirty percent were given treatment for a different condition. And 13% were told there was nothing wrong.

One major issue has been distinguishing ovarian cancer symptoms from those of common gastrointestinal and urinary conditions. In another study, my team and I found that patients with ovarian cancer have symptoms with a recent onset and occur more than 50% of the month.

To facilitate early detection of ovarian cancer, my team and I compared the symptoms ovarian cancer patients experienced with those of patients without ovarian cancer. We developed an index that identified six important symptoms of ovarian cancer: bloating, increased abdominal size, feeling full quickly, difficulty eating, pelvic pain and abdominal pain. Symptoms needed to occur more than 12 times a month but to have lasted for less than a year.

Based on these criteria, our index was able to detect ovarian cancer in 60% to 85% of the patients in our study, a range similar to that achieved through diagnostic blood tests for ovarian cancer.

Person talking to doctor in exam room
Recognizing the symptoms of ovarian cancer could lead to earlier diagnosis. FatCamera/E+ via Getty Images

Preventing ovarian cancer

While early detection is important, there are also prevention strategies that can help reduce the risk of developing ovarian cancer.

If you have a family history of ovarian cancer, inform your doctor, who may recommend genetic testing to fully determine your risk, or prophylactic surgery to prevent the development of cancer.

Oral contraceptives, tubal ligation (or surgery to close the fallopian tubes), pregnancy and breastfeeding all reduce the risk of ovarian cancer.

Finally, up to 70% of ovarian cancers may arise from the fallopian tubes. Removing the fallopian tubes at the time of another surgery may be another option to help reduce the risk of ovarian cancer. This should be done only if you do not plan on becoming pregnant in the future.

Can taking vitamins and supplements help you recover from COVID?

Can taking vitamins and supplements help you recover from COVID?

Published: May 10, 2022 6.00am AEST

Author

  1. Treasure McGuire Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and Associate Professor (Clinical), The University of Queensland

Disclosure statement

Treasure McGuire 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.

University of Queensland provides funding as a member of The Conversation AU.

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Australia’s surge in COVID cases this year has seen many people looking for ways to protect themselves or boost their immunity and recovery. An upswing in sales of dietary supplements has followed.

In Australia, the Therapeutic Goods Administration includes vitamins, minerals, amino acids, enzymes, plant extracts and microbiome supplements under the term “complementary medicine”.

The supplement industry’s global estimated worth  was about US $170 billion (A$239 billion) in 2020. Australian complementary medicines revenue was estimated at A$5.69 billion in 2021 – doubling in size over the past decade. The latest data shows 73% of Australians bought complementary medicines in the previous year, with vitamins featuring in more than half of purchases.

But how likely are these purchases to be effective in preventing COVID or treating it?

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Fear, avoidance and laboratory studies

Historically, the public has purchased supplements from sources that also provide health-care advice. Lockdowns and blanket health messages about social distancing and personal hygiene have created a new normal. So people are doing more shopping online for supplements and turning to the internet, friends or social media for vitamin recommendations. For some, this has led to an unhealthy fear of COVID (coronaphobia) and negative impacts on daily life.

As with any medicine, consumers should seek information from reliable sources (doctors, pharmacists or evidence-based peer-reviewed articles) about the potential benefits and harms of supplements before purchase. Strong evidence supports vaccination as effective against the acute respiratory symptoms of COVID. Researchers have also looked at whether supplements may prevent or reduce the duration and severity of this viral infection by boosting the immune response.

Deficiencies in essential nutrients that support immune function (vitamin C, vitamin D, zinc and selenium) have been shown to increase susceptibility to infection, including COVID. But there is little evidence supplementation in a healthy person prevents respiratory infections such as COVID. An evidence gap exists between a supplement’s action in laboratory or animal studies and findings from well designed and conducted clinical trials.

couple browse vitamin aisle in supermarket
The dietary supplementary industry has doubled in size over the last decade. Shutterstock

Read more: No, CBD is not a miracle molecule that can cure coronavirus, just as it won’t cure many other maladies its proponents claim


A pandemic ‘infodemic’

Ready access to supplements without a prescription from a myriad of online and shopfront sources and the uncontrolled spread of claims that supplements can prevent or treat COVID symptoms, has created an “infodemic”.

These claims are fuelled by supplement manufacturers being able to “list” their products on the Australian Register of Therapeutic Goods, with limited evidence of safety or effectiveness. This appearance of official approval tallies with the common misperception that “natural” means “safe”.

Supplements can cause harm in the form of adverse effects, drug interactions and expense. They also add to a patient’s medication burden, may delay more effective therapy, or give false hope to the vulnerable.


Read more: Lemon water won’t detox or energise you. But it may affect your body in other ways


Vitamins A to zinc

The recent COVID A to Z Study illustrates some of the challenges involved.

It was designed to test the effectiveness of high-dose zinc, vitamin C, and a combination of both, to shorten the duration of COVID-related symptoms compared with usual care in adult outpatients with confirmed infection.

These nutrients were chosen because:

  • vitamin C studies in mice showed this antioxidant to be essential for antiviral immune responses against the influenza A virus, especially in the early stages of the infection
  • deficiency of zinc, an essential trace element, has been associated with increased susceptibility to viral infections.

The authors planned to include 520 patients but the safety monitoring committee recommended the study be stopped early, due to low likelihood of detecting significant outcome differences between the groups. There were also more adverse effects (nausea, diarrhoea, and stomach cramps) reported in the supplement groups than those receiving usual care.

Little evidence of benefits

Despite the large variety of complementary medicines marketed, most clinical trials to date have studied the impact of vitamin D, vitamin C or zinc to reduce the risk of contracting COVID, improve rates of hospitalisation or death.

Even with high treatment doses, results have been generally disappointing. Vitamin D, zinc and some probiotics may be beneficial to prevent viral infections. Vitamins D, C, A, zinc, calcium and some probiotics may be beneficial to treat viral infections. But other supplements studied (including copper, magnesium, selenium and echinacea) are unlikely to be beneficial or are not supported by sufficient data.

However, supplements may be beneficial when individuals are unable to achieve a balanced and varied diet.


Potentially harmful

High doses or chronic use of COVID supplements have also been linked with adverse effects: vitamin D with muscle pain and loss of bone mass; vitamin A with elevated liver function tests and blurred vision; vitamin E with bleeding risk; plant extracts, magnesium with gastrointestinal effects; and selenium with hair loss and brittle nails.

So, the evidence is not convincing that taking vitamins and supplements will prevent you catching COVID or help you recover from the infection, unless you have a known nutrient deficiency or a poor diet

Can Covid Lead to Impotence?

Can Covid Lead to Impotence?

Some studies find higher rates of erectile dysfunction among men recovering from the illness. But other factors related to the pandemic, like heightened anxiety, may also be to blame.

A patient with long Covid is examined in a hospital in Israel. Some research indicates that the coronavirus may linger in cells in the male genital tract.
A patient with long Covid is examined in a hospital in Israel. Some research indicates that the coronavirus may linger in cells in the male genital tract.Credit…Amir Cohen/Reuters
Roni Caryn Rabin

By Roni Caryn Rabin

  • May 5, 2022

For a respiratory disease, Covid-19 causes some peculiar symptoms. It can diminish the senses of smell and taste, leave patients with discolored “Covid toes,” or even cause a swollen, bumpy “Covid tongue.”

Now scientists are examining a possible link to an altogether unexpected consequence of Covid: erectile dysfunction. A connection has been reported in hundreds of papers by scientists in Europe and North America, as well as in Egypt, Turkey, Iran and Thailand.

Estimates of the magnitude of the problem vary wildly. A paper by Dr. Ranjith Ramasamy, director of reproductive urology at the University of Miami’s Desai Sethi Urology Institute, and his colleagues found that the risk of erectile dysfunction increased by 20 percent after a bout with Covid. Other investigators have reported substantially higher increases in that risk.

When patients first started coming to Dr. Ramasamy’s clinic complaining of erection problems, “We dismissed it, thinking it was all psychological or stress induced,” he said.

But over time, he and other physicians began to see a pattern, he said. “Six months after the initial infection, patients had gotten better overall, but they continued to complain of these problems,’’ including both erectile dysfunction and low sperm counts, Dr. Ramasamy, who has written several papers on the topic, said.

At the outset of the pandemic, Dr. Emmanuele Jannini, a professor of endocrinology and medical sexology at the University of Rome Tor Vergata, reported a strong link between erectile dysfunction and Covid. When he compared men who had been ill with Covid with those who had not, he found that those who had been infected were nearly six times as likely to report impotence as those who had avoided the coronavirus.

“Communicating that the disease can affect your sexual life is a tremendously powerful message,” especially for men who still resist vaccination, Dr. Jannini said in an interview. “The evidence is very strong.”

Research from imaging scans and biopsies indicates that the coronavirus can infect tissue within the male genital tract, where it may linger long after the initial infection. Scientists say it is too early to be certain that the link to erectile dysfunction is causal, since so many factors — psychological as well as physiological — play a role in producing and maintaining an erection. The pandemic has led to social isolation and a surge in anxiety and depression, all of which may play a role.

“Men’s erections are more complicated than people think,” Dr. Justin Dubin, who co-wrote a paper about the adverse impact of Covid on men’s health, said.

“You need good blood flow, you need the nerves to be firing, and you need good hormone levels, specifically testosterone,” he said. “But you also need to be in a good state of mind, and you also need to be aroused. If any of these things go wrong, you may have an issue getting an erection.”

In that sense, the pandemic is the perfect confluence of converging factors for causing erectile dysfunction, Dr. Joseph Katz, a professor at Florida College of Dentistry, said. Dr. Katz stumbled on the issue of erectile dysfunction while investigating Covid’s effects on oral health.

Some researchers speculate that erectile dysfunction may be linked to the well-documented loss of the ability to taste and smell experienced by Covid patients, because these senses play an important role in sexual arousal. “It is through smells that the arousal mechanism in the brain is ignited,” three Italian urologists wrote last year in a letter responding to Dr. Jannini’s paper.

Vascular problems can manifest in the sexual organs first, because the vessels there are small. “When I see a guy for erectile dysfunction, they don’t just get a Viagra or Cialis prescription,” Dr. T. Mike Hsieh of the University of California, San Diego, said.

At the very least, men need healthy blood vessels and good blood flow in order to develop and sustain erections. The coronavirus may damage blood vessels and the lining of the vessels, called the endothelium, as it binds to the molecular receptors that are plentiful on endothelial cells.

The vessels may not constrict and stretch as needed to allow for blood flow to the penis. Injury to the blood vessels may also contribute to more serious complications of Covid, like heart attacks, strokes and abnormal clotting.

The coronavirus invades cells in the penis and testicles of monkeys, researchers discover.

“Our entire vascular system is connected — it’s not an isolated penis problem,” Dr. T. Mike Hsieh, director of the men’s health center at University of California, San Diego, said.

But vascular problems can manifest in the sexual organs first, because the vessels there are so small. (Dr. Jannini calls erectile dysfunction “the canary in the coal mine” for cardiovascular disease.) Erectile dysfunction and cardiovascular disease share risk factors — such as being severely overweight, having metabolic diseases like diabetes, smoking and older age — which also increase the odds of having severe Covid.

“The artery for the penis is one-tenth the size of a coronary artery, and when you have a narrower vessel, whether it’s a plumbing problem or a vascular problem, it will show up there first, even before you see it in a larger artery,” Dr. Hsieh said.

Erectile dysfunction can precede a heart attack by about five years, he said, and can be an early signal that there are other underlying risk factors.

“When I see a guy for erectile dysfunction, they don’t just get a Viagra or Cialis prescription,” Dr. Hsieh said. “They get a referral to a primary care colleague or a cardiologist to make sure their cholesterol is in check, their diabetes is under control, to discuss weight management, lifestyle or dietary changes.”

Erectile dysfunction may point the way to better diagnosis of long Covid, Dr. Jannini said, or even deteriorating mental health.

“If you have a patient who survived Covid, and you want to know if he has long Covid or not, just ask him how it’s going in bed,” Dr. Jannini said. “If he’s having a normal sex life, the possibility of him having serious long Covid is very, very low.”

Left untreated, erectile dysfunction can lead to further complications. Cases of Peyronie’s disease, a condition that causes curved, painful erections as a result of fibrous scar tissue built up in the penis, and orchitis, the inflammation of one or both of the testicles, have developed in men who have had Covid, according to published research.

Men who don’t have normal erections for several months at a time may develop scar tissue and fibrosis, which makes erectile dysfunction harder to treat and may even lead to shortening of the penis.

Erectile dysfunction can resolve on its own, but Dr. Hsieh encouraged men with symptoms to see their physicians, and sooner rather than later.

“If you’re having these problems, do not wait,” he said. “For the most part, we can get the guys’ sex lives back.”

A version of this article appears in print on May 6, 2022, Section A, Page 18 of the New York edition with the headline: Global Studies Tie Covid To Erectile Dysfunction. Order Reprints | Today’s Paper | Subscribe

Covid Vaccine and Women’s Hormones

Dr Nixon and myself have both witnessed the same thing. Many of our female patients have been presenting with a number of unpleasant symptoms over the last 6 months – such as severe fatigue, lower abdominal pain, muscle aches and pains, headaches, brain fog, unexplained periods, etc. Neither of us have ever experienced the number of women complaining of these symptoms after having been doing well with their hormones over the years. We can only suspect that the vaccine may be responsible – we have no other way of knowing as the medical profession have an embargo on this kind of information becoming public. I AM NOT ANTI-VAXXER. My wife and I have both been fully vaccinated. However, I refuse to hide my head under a pillow and ignore what is happening. This is very concerning.

Women’s Menstrual Anomalies Lead to Massive Research Study

April 26, 2022

My Cycle Story Study

Background

Spring of 2021 ignited a conversation on social media. Thousands of women were experiencing dramatic changes in their menstrual cycle and sharing those traumatic experiences. The conversation launched a myriad of profiles and Facebook groups where women shared personal stories of their strange irregularities.

After a Facebook group containing over 20k members and testimonies was deleted, it was evident that censorship on social media was going to prevent this conversation from continuing. The stories these women were sharing were being suppressed. In response, the MAMM team decided to leverage their network of experienced and published researchers, physicians and OB/GYN doctors to find a way to ensure that these women’s experiences were not going unnoticed.

The need to research these occurrences and give a voice to the women who were silenced was obvious. MyCycleStory(sm) survey was created by members of the MAMM team and their expansive network of experts, along with  Children’s Health Defense., It was imperative to capture these testimonies and bring the desperately needed conversation back to life.

What Was Found

As the submissions were collected over several months, it was clear there was something very serious and concerning happening to women. Along with several severe, irregular experiences, a massive increase in the extremely rare event of “decidual cast shedding” was reported by many women who responded to the MyCycleStory(sm) survey. As the submissions were collected, this discovery was worth looking into first, independent of other experiences. According to WebMD, “A decidual cast is a large, intact piece of tissue that you pass through your vagina in one solid piece. It happens when the thick mucus lining of the uterus, called the decidua, sheds in the near exact shape of your uterine cavity, creating a triangular ‘cast.”

This occurrence is painful and often traumatic as it’s not something that many women, nor their doctors, have seen or experienced or even heard of.

After looking through historical data surrounding women and the incidence of decidual cast shedding, researchers confirmed that the event was extremely rare, having found only around 40 cases studied over the last 100+ years. The MyCycleStory(sm) survey participants reported this occurrence 292 times over the course of 7 months after January 2021.

Looking back, the cause is relatively unknown. Things like stress, hormonal contraceptives, and ectopic pregnancies were considered possibilities in the past, but the data in this particular study does not support those conclusions. With the distribution of the COVID-vaccine around the same time we started seeing these reactions, we cannot help but wonder if there is a correlation that warrants further investigation.

Why This Matters

The conversation around the effects of fertility that COVID and the COVID-vaccine may be having on women needs to happen right now. With the CDC and government agencies assuring that the vaccine is safe for women and children, the research collected in this study warrants questioning the validity of that statement.

In the recently released Pfizer clinical trial data, it’s stated that the fertility effects are unknown. So why are they saying it’s safe if they don’t know for sure?  Why are they suppressing the stories of these women who are experiencing something so rare and traumatic? What is causing such a surge in a seemingly rare and traumatic experience? Could exposure to spike protein play a role? Is the temporal association with vaccine distribution more than coincidence?

All of these questions need to be addressed immediately.

What’s Next

This study begins of one of the most important conversations needed today. The MyCycleStory(sm) team continues to dive into the other reported symptoms and their potential causes. Subsequent publications will focus on menstrual abnormalities not only in women of reproductive age but in post-menopausal women as well.

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How do I improve my motivation to exercise when I really hate it? 10 science-backed tips

How do I improve my motivation to exercise when I really hate it? 10 science-backed tips

Published: April 14, 2022 3.30pm AEST

Authors

  1. Carol Maher Professor, Medical Research Future Fund Emerging Leader, University of South Australia
  2. Ben Singh Research fellow, University of South Australia

Disclosure statement

Carol Maher receives funding from the National Health and Medical Research Council, the Medical Research Future Fund, the National Heart Foundation, the South Australian Department for Innovation and Skills, the South Australian Department for Education, Healthway and Hunter New England Local Health District.

Ben Singh 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.

University of South Australia provides funding as a member of The Conversation AU.

CC BY NDWe believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.

We’ve all heard those people who say “running gives you a high” or “exercise is addictive,” but for many of us, it’s hard to love exercise. Some might even say they hate it, dread it, or the thought of going to the gym gives them anxiety.

Why do some of us hate exercise? And how can we overcome this to reap the lifesaving benefits of getting the body moving?

Humans didn’t evolve to ‘exercise’

Throughout most of human history, food was scarce and being active wasn’t a choice. For millennia, humans had to move to find food, and once they were fed, they rested to conserve energy, because they didn’t know where their next meal was coming from.

So, if you have the urge to sit down and watch Netflix rather than going to the gym, you might take solace in the knowledge resting is a natural human tendency.

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Having said that, our 21st-century lifestyles involve far too much sitting and resting. With technology, cars, and other labour-saving devices, moving is no longer necessary for daily survival.

Man sitting at desk
Movement is no longer necessary for our daily survival. Shutterstock

Yet, being physically inactive is terrible for our health. A meta-analysis published in prestigious medical journal The Lancet found physical inactivity is associated with a 30-40% increased risk of colon cancer, 30% increased risk of breast cancer, 20-60% increased risk of type 2 diabetes, and a 30-50% higher risk of premature death, compared with being physically active.

So how much physical activity do you actually need?

It’s recommended Australian adults (aged 18-65) get at least 150 (though preferably 300) minutes of moderate-intensity physical activity each week. Moderate intensity exercise might be a brisk walk, light cycle or mowing the lawn.

If you are willing to do vigorous physical activity, you only need half that (75-150 minutes per week). Vigourous activity is anything strenuous enough you would struggle to have a conversation: jogging, or running around playing a sport like footy or tennis.

A variety of activity types are encouraged since different physical activities entail different benefits. Muscle-strengthening exercises, like lifting weights or doing push ups, are encouraged twice a week, to keep bones and muscles strong.

If that is all starting to sound too complicated, rest assured ANY exercise is good for you. You don’t have to achieve the physical activity guidelines to benefit from physical activity.

What are some science-backed tips for getting motivated?

According to psychologists there are two main types of motivation: extrinsic and intrinsic motivation. Intrinsic motivation arises from within – doing something for the personal reward or challenge of it. Extrinsic motivation comes from external factors, like trying to earn a reward or avoid a punishment.

You can boost your intrinsic motivation by identifying why exercising is important to you.

1. Identify your “why” – do you want to exercise for your health? Is it for your kids? Is it for how working out makes you feel? Exercise has long-term benefits for health and function, flow-on benefits for your children, and immediate effects on mood and vitality. Being clear in your mind about what you want to gain from exercising, can help prompt you into action.

Woman on yoga mat thinking
Thinking about why you want to exercise can help your intrinsic motivation. Shutterstock

Extrinsic motivators can also help you get started with exercise.

2. Arrange to meet a friend to exercise together. You’ll be more likely to follow through, as you won’t want to let your friend down. Also, research suggests people exercise for longer when they exercise with family members and friends compared with those who exercise alone

3. reward yourself with a new piece of clothing or shoes you’ll enjoy exercising in. Be sure to make the reward conditional on doing a certain amount of exercise, so you have to earn it

4. get an activity tracker. Fitness trackers have a host of features designed to boost motivation, such as prompts, self-monitoring and goal-setting. There is a plethora of research suggesting activity trackers increase physical activity

5. exercise at the same time each day, so it becomes a habit. Research suggests exercising in the morning leads to faster habit formation compared with evening exercise

6. do an activity you enjoy. Starting a new exercise habit is hard enough. Increase your chances of sticking with it by doing an activity you find enjoyable. Also, you may exercise at a higher intensity without even realising it, if you are doing a form of exercise you enjoy. If you hate running, don’t do it. Go for a long walk in nature

7. start small. Leave yourself wanting more, rather than overdoing it. You’re also less likely to feel sore or injure yourself

8. listening to up-beat music improves mood during exercise, and reduces perceived exertion, leading to increased work output. These benefits are particularly effective for rhythmic, repetitive forms of exercise, such as walking and running

9. take your dog for a walk. Dog-walkers walk more often and for longer than non-dog walkers, and they report feeling safer and more socially connected in their neighbourhood

Woman walking dog in wooded area
People who walk with dogs walk more often and for longer. Shutterstock

10. make a financial commitment. Behavioural economic theory recognises humans are motivated by loss aversion. Some commercial websites have harnessed this for health by getting people to make a “commitment contract” in which they pay a financial deposit that is forfeited if the health behaviour commitment is not met. This approach has been shown to improve physical activity, medication adherence and weight loss.

Be patient with yourself, and keep the long game in mind – it takes around three to four months to form an exercise habit. After that, the intrinsic motivators take over to keep your exercise routine going. Who knows, maybe you’ll be the one hooked on exercise and inspiring your friends and family a few months from now.

Staff Shortages.

We are very short staffed at present, due to people being away for a variety of reasons. This makes it very hard to get through to the clinic, leading to frustration and angry patients. The few staff left working are doing the best they can, but it is not easy for them. I have taken to ringing those of you who have a telephone appointment, so keep the lines free at the time of your appointment. If you need to make an appointment, do it on-line. If you need a prescription or path form, email me with your request. Hopefully things will improve soon. We are living in exceptional times.

Menstruation Gets a Gen Z Makeover

Menstruation Gets a Gen Z Makeover

Young people want alternatives to disposable tampons and pads — and they’re not embarrassed to talk about it.

Sapna Palep is launching a line of undergarments, which will include period-friendly underwear, along with her daughters, Anaya (left) and Aviana Campello-Palep.
Sapna Palep is launching a line of undergarments, which will include period-friendly underwear, along with her daughters, Anaya (left) and Aviana Campello-Palep.Credit…Olivia Galli for The New York Times

By Pooja Makhijani

Published Jan. 20, 2022Updated Jan. 24, 2022

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When Sapna Palep was younger, she was mortified by conversations about menstruation. “It was like, ‘Let’s not talk about this, I need to leave the room,’” said the 43-year-old mother of two. The mere mention of periods evoked “pure embarrassment and fear.”

Ms. Palep’s 9-year-old daughter, Aviana Campello-Palep, in contrast, approaches the topic with zero self-consciousness or hesitation. “When my friends talk about getting their period, they just talk about it,” Aviana said. “It’s just normal in a girl’s life.”

These frank conversations have led Ms. Palep and her daughters, Aviana and Anaya, who is 8, to create Girls With Big Dreams, a line of undergarments for tweens, which includes reusable period underwear that offers an environmentally friendlier alternative to disposable pads and tampons; their brand will launch in early February and be sold online.

“I’m hopefully going to make a difference in somebody’s life so they’re not embarrassed at some point by something that’s so normal,” Aviana said.

The Campello-Palep girls are representative of two emerging trends that have become clear to period advocates, and anyone who casually follows #PeriodTok: Members of Gen Z and beyond are more forthcoming about their periods than generations past, and they are more likely to care whether the products they use are environmentally sustainable. The convergence of the two ideals may signify a cultural shift in how young people are approaching menstruation.

More options for reusable period products like absorbent underwear, menstrual cups, cloth pads and panty liners, and applicator-free tampons are on the market now than ever before — some made just for teens and tweens.

“This whole movement is youth-driven,” said Michela Bedard, executive director of Period Inc., a global nonprofit focused on providing access to period supplies and ending period stigma. “Young menstruators are having a completely different experience in terms of managing their periods with reusables throughout their life.”

Reusable products represent only a fraction of menstruation supplies purchased in the United States — Americans spend $1.8 billion on pads and $1 billion on tampons yearly, which dwarfs sales of all other products combined. But the market share for reusable products is expected to grow through the next decade, according to forecasters, largely fueled by the wider acceptance and availability of menstrual cups in Western countries. Still, the average menstruator can use thousands of tampons in their lifetime. And single-use plastic menstrual products take about 500 years to decompose, a 2021 report from the United Nations Environment Programme found.

Members of Gen Z, who studies find are more likely to get involved in climate change and sustainability efforts than previous generations, are teaching their parents about new ways to handle their monthly cycle openly and sustainably.

“I used to have conversations about how to hide your tampon or pad up in your sleeve or in your shorts or in your pants,” said Dr. Cara Natterson, who is a pediatrician; the author of American Girl’s best-selling “The Care and Keeping of You” series; and founder of Oomla, a gender- and size-inclusive line of bras and puberty products. “I do not have that conversation anymore because the kids go, ‘Why should I hide my tampon and my pad?’ They are 100 percent right.”

Dr. Natterson’s 18-year-old daughter has educated her about new products in the marketplace, some of which she discovers from Instagram influencers or #PeriodTok videos. “Teens are looking for conversations around people’s experiences, not five-star Amazon reviews,” she said. Dr. Natterson recently considered using cloth pads again after a failed experiment with them years ago, at her teenager’s behest. “They didn’t work super well when they were first being invented and iterated,” she said. “My daughter said, ‘You got to try them again.’”

Environmental sustainability and menstruation may be having a moment, but it’s not the first time, said Lara Freidenfelds, a historian of health, reproduction and parenting, and author of “The Modern Period: Menstruation in Twentieth-Century America.” Homemade menstrual rags were the norm through the turn of the 20th century, up until Kotex became the first successfully mass-marketed pad in 1921. Modernity equaled disposability, and the brand was aspirational, she said.

The first robust discussions of sustainability in menstrual care started in the 1970s as people experimented with cloth pads and sponges. “There have always been young people who were idealistic and thought about these things but did not find the products available to be practical,” she said. Sustainability has historically been sacrificed for the sake of convenience, she added.

Today, parents of Gen Zers benefit from improvements in menstrual technology: The cloth pads of yore are not the cloth pads of today; and period underwear, for example, is made of highly absorbent fabric without being bulky. New menstruators often turn to a parent for products and advice — now parents can hand over more than a disposable pad or tampon, potentially rerouting some of the more than 15 billion disposable products that end up in landfills every year in America.

“The world we’re going to have when these progressive Gen Zers become parents in 20 years — that’s going to be fascinating,” said Nadya Okamoto, a former executive director of Period Inc. and co-founder of the sustainable menstrual products brand August.

Despite these cultural shifts and advances in technology, there are significant barriers to widespread use of reusable or recyclable products. “When you first get your period, pads are the easiest thing to find and buy,” said Anaya Balaji, who is 13. “If you go into the school bathrooms, they’re stocked with Always,” she added, referring to the disposable brand’s ubiquitous presence in her California high school. As an online community leader for the Inner Cycle, a virtual forum for the August brand, Anaya connects with her peers on social media to provide education and awareness. “You can find the products out there that fit your body and that work good for you and good for the environment,” she said.

Still, some young people can’t afford reusable products, especially in communities where period poverty — or the lack of access to menstrual products — is an issue. “Even though the investment in a $25 pair of underwear or a $60 cup would save you money, a lot of people don’t have that money every month,” said Ms. Bedard, whose organization serves the economically disadvantaged.

Like disposable products, reusable and recyclable products are also subject to a “tampon tax” — a tax that is levied on products that are deemed nonessential — in many states. Activists argue that such taxes are sexist and discriminatory and have fought to repeal them nationwide through legislative action. In 2021, several states, including Louisiana, Maine and Vermont, nixed the tax.

The Campello-Paleps hope their line of products will help young people handle their monthly cycle with less shame.
The Campello-Paleps hope their line of products will help young people handle their monthly cycle with less shame.Credit…Olivia Galli for The New York Times

The cultural stigma that plagues menstruation also stubbornly persists, despite the best efforts of young people to normalize periods. Patriarchal taboos around virginity, purity and “dirtiness” in many cultures and religions quash conversation and can impede the use of internal menstrual products, such as tampons or cups.

Corporate messaging still largely emphasizes discreetness and cleanliness, which makes periods seem dirty or bad, said Chella Quint, a menstrual activist, educator and author of “Own Your Period: A Fact-filled Guide to Period Positivity.” “For a long time, the disposable menstrual product industry was hugely responsible for propagating and perpetuating the sort of negative taboos that keep people down and frightened,” she added.

Menstrual health is a public health issue and has no gender, Dr. Natterson said. To combat taboos around the subject, anyone, even those who don’t menstruate, should be able to speak freely about periods too, she said. Dr. Natterson said she’s made sure her 16-year-old son knows to hand his sweatshirt to a classmate who has a blood stain on their pants, and to have a tampon or pad to share.

“Teaching everyone to respect other people’s bodies — everyone needs to be part of that conversation,” she said.