Monthly Archives: May 2023
Adenomyosis: from symptoms to treatment, two women’s health experts explain this little known condition
Adenomyosis: from symptoms to treatment, two women’s health experts explain this little known condition
Published: May 26, 2023 9.23pm AEST
Authors
- Jen SouthcombePrincipal Investigator/Group Leader, Nuffield Department of Women’s and Reproductive Health, University of Oxford
- Nura Fitnat Topbas SelcukiPhD Candidate, Nuffield Department of Women’s and Reproductive Health, University of Oxford
Disclosure statement
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
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BBC presenter Naga Munchetty recently revealed that she suffers from adenomyosis, a chronic condition that affects the uterus. She spoke of how her pain can leave her unable to move and how a recent flare-up was so intense her husband had to call an ambulance.
Yet many people have never heard of this condition, despite it affecting as many as one in five women.
Adenomyosis can cause symptoms including irregular and heavy menstrual bleeding and pelvic pain. The severity of symptoms varies between patients – up to one-third of women with adenomyosis may have minimal or no symptoms at all.
The condition can also affect fertility. Women with adenomyosis who do become pregnant have an increased risk of miscarriage, pre-term delivery, pre-eclampsia and bleeding after delivery.
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So what causes adenomyosis, and how is it diagnosed and treated? There’s still a lot we don’t understand about this condition, but here’s a bit about what we know so far.
What causes adenomyosis?
There are two key layers in the uterus. The endometrium is the inner layer where embryos implant. If there is no pregnancy, this layer is shed during a period. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions. In people with adenomyosis, endometrium-like cells are found in the wrong place – the myometrium.
Although a large number of women with adenomyosis have endometriosis as well, adenomyosis is a distinct disease from endometriosis. In endometriosis, endometrium-like cells are also found in the wrong place, but in this case outside of the uterus, mainly in the pelvic cavity.
Thanks to research, public engagement and social media, awareness of endometriosis has increased in recent years. Yet adenomyosis is still relatively unheard of.
Read more: Adenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it
Diagnosis options are changing and improving
Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrium-like cells in the myometrium could only be verified by pathology assessment where the myometrium is examined under a microscope after a hysterectomy (surgery to remove the uterus).
Recent years have seen increased diagnoses with the development of imaging technologies such as MRI and detailed pelvic ultrasound. Although adenomyosis is now commonly identified without the need for a hysterectomy, doctors are still working towards developing a standardised method for non-surgical diagnosis.
As a result, it remains uncertain exactly how many women have adenomyosis. Although we know that around 20% of women having hysterectomies for reasons other than suspected adenomyosis are found to have evidence of the condition on pathology assessment.
Adenomyosis is a complex condition
The type of adenomyosis tissue growth in the myometrium can be either focal lesions (affecting a part of the uterus) or diffused (affecting a wide area of muscle). Adenomyosis can be further classified depending on the depth of endometrial-like tissue invasion into the myometrium. Scientists and doctors are still investigating whether the type or depth of the lesions relates to symptoms – the severity of symptoms and lesions don’t always tally.
We don’t yet understand why some women develop adenomyosis, though evidence shows there is an increasing prevalence with age.
It is thought that the region between the endometrium and myometrium becomes damaged, either by the natural processes of the menstrual cycle, pregnancies and childbirth, or medical procedures. In some women, damage to the endometrial tissue layer does not heal as it should and the endometrium-like cells enter and grow abnormally into the myometrium. These disrupt the normal functions of the myometrium leading to pain and bleeding.
It’s possible that a variety of mechanisms may contribute, and that there is not one common disease-causing factor behind adenomyosis.
How is adenomyosis treated?
Treatment strategies include hormonal medications such as oral contraceptives, progesterone-containing pills, the insertion of a progesterone-releasing coil (for example, Mirena), or a drug called GnRHa that stops the natural production of sex hormones. Non-hormonal treatments include tranexamic acid. These treatments aim to minimise menstrual bleeding. Pain is often treated with non-steroidal anti-inflammatory drugs.
Treatments that work for some women don’t for others, adding weight to the argument that there’s more than one type of adenomyosis. Treatment strategies should be tailored to patients, depending on their fertility wishes and symptoms.
If medical treatments are not providing adequate relief from symptoms, there are surgical options, namely removal of the focal lesions or a hysterectomy.
Read more: Endometriosis: three reasons care still hasn’t improved
What lies ahead?
Although adenomyosis is a common disorder that affects many women, including those of reproductive age, it doesn’t receive enough clinical and research attention. There is also a lack of knowledge and awareness around adenomyosis among many healthcare professionals and the public. This needs to change so we can improve our understanding of the condition, diagnosis and treatment options.
Scientists and doctors who specialise in adenomyosis are still on the quest to find an accurate, non-invasive diagnostic method, and hopefully, one day, a cure.
Exhausted, disconnected and fed up – what is ‘parental burnout’ and what can you do about it?
Exhausted, disconnected and fed up – what is ‘parental burnout’ and what can you do about it?
Published: May 22, 2023 6.00am AEST
Author
- Alan RalphHonorary Principal Fellow, School of Psychology, The University of Queensland
Disclosure statement
The Parenting and Family Support Centre is partly funded by royalties stemming from published resources of the Triple P – Positive Parenting Program, which is developed and owned by The University of Queensland (UQ). Royalties are also distributed to the Faculty of Health and Behavioural Sciences at UQ and contributory authors of published Triple P resources. Triple P International (TPI) Pty Ltd is a private company licensed by UniQuest Pty Ltd on behalf of UQ, to publish and disseminate Triple P worldwide. Dr Ralph has no share or ownership of TPI but receives royalties and consultancy fees from UQ and TPI. Dr Ralph is an Honorary Principal Fellow at UQ.
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For many parents, the reality of juggling the demands of caring responsibilities on their time, energy and resources leaves them with little time to take care of their own wellbeing. This can result in “parental burnout”.
Although the exploration of parental burnout is relatively new, research has identified it as a prevalent issue across global communities and cultures. It’s reported in countries around the world, with the highest prevalence rates rising to 8% of parents in Poland, the United States and Belgium.
You could be forgiven for thinking there’s a simple solution to this growing concern: relax and get some sleep! But again, the reality can be far different.
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4 signs of parental burnout
Parental burnout is not just a buzzword. It’s a growing syndrome that results from chronic parenting stress. It is characterised by four main symptoms for parents:
- experiencing physical or emotional exhaustion – or both
- feeling shame about their parenting, or that they’re not as good a parent as they used to be
- feeling overwhelmed or “fed up” with the role of being a parent
- feeling emotionally disconnected from their children.
Despite many feeling this way, recent research shows 60% of parents don’t routinely do anything to relax and recharge. This research reports two in five parents feel tiredness impacts their ability to be the kind of parent they want to be, and nearly half of all parents think there’s not enough time in the day to get everything done.
And that’s the conundrum. It can be hugely challenging for caregivers to carve out time and space to look after themselves.
But when they do, it can have a positive impact on their physical and mental health, which can help them to manage the demands of parenting, so children and families benefit too.
Read more: Emotional abuse is a pattern of hurtful messages – building parenting skills could help prevent it
4 positive things parents can do
So what can parents and carers do to help prevent or reduce burnout when they’re already stretched so thin? Here are four things to explore:
1. Being less critical of yourself
As parents, we can all have days when we don’t feel like we’re doing our best. We may feel disconnected from our children, or emotionally and physically drained. This is where “self-compassion” comes in – being a little kinder to ourselves when we feel stressed or experience setbacks. Not only is this good for parents and carers, it can be a key life skill they can model for their children.
Even though it can be overlooked, or its importance downplayed, self-compassion is a crucial form of self-care. Moreover, research has shown parents who are kind to themselves and prioritise self-care have better overall health and well-being. They also feel more confident in their parenting skills and have more positive interactions with their children. And parent’s well-being, confidence and positive interactions with their children are strongly linked to better outcomes for children, including those with mental health challenges or disability.
Even if you make mistakes or your inner critic starts chiming in, try to reframe its voice into a more positive one. Remember, everyone faces challenges and there is no such thing as a perfect parent or child. Adopting this mindset can help.
2. Reframing self-care
As a parent or carer, it’s common to put your own needs last and see self-care as an optional extra – something that takes precious time away from the responsibilities of parenting, or simply so low on the long list of priorities that it slips off.
However, taking care of yourself is the opposite of being selfish. Parents who prioritise self-care tend to be less self-critical and have better physical and mental health. They also feel more skilled and confident as parents, are able to focus on parenting tasks better – even during stressful times – and are more likely to enjoy parenting.
It can be helpful to remember self-care isn’t just a “nice to have” option. And it’s not selfish to put your needs back into the picture – rather, it’s an important parenting skill that benefits everyone.
Read more: Your kid is having a meltdown in the supermarket. In tough parenting moments, here’s what you can do
3. Remembering small, everyday moments of self-care have a big impact
The concept of self-care is often portrayed as a special treat or occasional, expensive indulgence. However, it can be more about those small, every day, under-the-radar actions that might only take a few minutes, or even seconds, but can set up positive patterns that can help parents to feel more balanced. Something as simple as pausing to take some slow, deep breaths, going for a short walk in the fresh air or chatting with a supportive friend can help.
Even minor actions can add up over time to help parents navigate ups and downs more positively.
4. Asking for help
Parental burnout is one part of a larger conversation around the realities of being a parent or carer. There are often multiple factors at play that can contribute to burn out, such as lack of support, high levels of responsibility, the impact of natural disasters, looking after ageing parents and financial concerns.
It’s important for parents and carers to be mindful of the signs of burnout, and to seek help where needed. By addressing this issue as one important part of the broader parenting and care-giving journey, we can work towards creating more resilient, positive family environments for parents and children alike.
It is important to acknowledge that it is usually women who shoulder more of the caring load. Partners, employers and extended family should be on the look out for signs of burnout and offer help before they are asked. Offering flexible work arrangements may be helpful, especially for those (for example, single parents) who may be doing it tough.
If parental burn out is affecting your day-to-day life, seek help through Lifeline, Parentline, your GP or an allied health professional. The Australian government has also made an evidence-based parenting support program available for free.
Huge new study shows mRNA Covid jabs sharply raise the risk of severe vaginal bleeds
URGENT: Huge new study shows mRNA Covid jabs sharply raise the risk of severe vaginal bleeds
The researchers then tried to downplay their findings; welcome to the age of vaccine-apologetic science
MAY 23, 2023
Women 45 and over had a high risk of severe vaginal bleeding after receiving mRNA Covid shots, Swedish researchers found after studying almost 3 million women.
The increased risk lasted for at least three months after women received a shot and was even higher after the third shot than the first two. That finding suggests what scientists call a “dose-response relationship,” strong evidence the link was not coincidence.
Overall, a third mRNA dose raised the risk of severe, medically diagnosed bleeding episodes by 25-45 percent. Some women required inpatient hospital care.—
Younger women also had a higher risk of bleeding episodes, although the researchers said hidden factors unrelated to the vaccine might have driven that finding.
Vaginal bleeding is not merely painful and uncomfortable. In about 9 percent of cases, severe bleeding episodes are a sign of cancer of the endometrium, the lining of the uterus. The researchers did not examine whether the extra bleeds were linked to increased diagnoses of endometrial cancer.
Because of its size and reliance on formal medical diagnoses rather than self-reporting of vaginal bleeding, the study offers the strongest evidence yet that the connection between Covid shots and bleeding is real.
Bizarrely, though, the researchers downplayed their own findings when they discussed the paper, which was published in the British Medical Journal.
Meanwhile, the Journal of the American Medical Association relegated the study to a three-paragraph summary in its “Medical News in Brief” section – and inaccurately reported that it had not found the jabs caused menstrual changes in women under 45. It did.
—
For the study, the researchers compared the likelihood a woman would be diagnosed with a new bleeding disorder up to one week and three months after being vaccinated with the same likelihood of diagnosis before vaccination.
The scientists drew on Sweden’s national medical records system, so they had a huge database, including 2.95 million women in Sweden aged 12-74. Of those, 2.58 million received at least one Covid jab and 1.65 million received three. The researchers divided women into two roughly equally-sized categories – 12-44 and 45 and over, whom they called post-menopausal. The study covered the period from December 2020, when vaccinations began, through February 2022.
After the third mRNA dose, post-menopausal women had over a 40 percent higher risk of severe bleeding. The risk lasted at least three months. It might have continued even longer, but the researchers did not examine time periods longer than three months after the shot.
Even after researchers corrected for factors other than the vaccine that might have caused the risk, they still found it was more than one-quarter higher. For all three doses combined, episodes of severe bleeding in older women rose by about 20 percent before correction and 15 percent after.
(Whole lotta bleeding going on: fifth column is the “crude” rate ratio, showing a 40-45 percent increased risk of severe vaginal bleeding. Sixth column shows the risk after researchers tried to correct for hidden factors.)
For younger women, bleeding rose by about 40 percent before correction but 10 percent after. It is possible the researchers overcorrected in ways that made the post-correction risk look smaller than it really is, but that question is very complex statistically.
In any case, the researchers found a statistically significant level of extra risk both before and after correction for both menstrual and postmenopausal bleeding.
These rates likely sharply understates the overall risk that the shots cause bleeding, because the study only captured bleeding episode severe enough to lead to a new formal diagnosis from a doctor Women with moderate bleeding would be likely to treat it themselves.
—
Yet – when they summarized the study – the researchers tried to downplay their own data, saying “the findings do not provide substantial support” for a causal link between mRNA jabs and the problems.
Again:
This study drew on an enormous database and had no sampling bias since almost all Swedish women were included.
The study did not depend on self-reporting but on actual medically diagnosed episodes of severe vaginal bleeding.
Even after the researcher added a number of “covariates” to try to look for hidden non-vaccine factors that might have raised the risk, the signal remained, though at a lower level.
The risk appeared dose-dependent, at least in women 45 and over.
—
All this raises the question of what exactly would researchers have classified as “substantial support” for a link.
Trust The Science.
Except if it raises questions about mRNA safety.
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| Allison BrennanWrites Murder She WritesMay 23I’ve pretty much come to the conclusion that no one in “power” will every admit that the mRNA shots are dangerous or have caused any severe injuries or deaths. Ever. Every study will be discarded or minimized or, like this one, they’ll conclude that the shots aren’t responsible even though the data says that they are. It’s tragic and people are going to continue to suffer. How many people have to stand up from Pharma and the FDA and say we’ve all been lied to? And if they’re lying about the mRNA shots, you know they are lying about other things as well.LIKE (88)REPLY |
Incredible moment paralysed man walks for first time in 12 YEARS after being fitted with mind-reading implant
We are very lucky to be living in these times. AI is going to have a dramatic impact on all of us. This article in the Daily Mail shows us just the beginning of the benefit from these new developments. It is mind boggling.
Friday, May 26th 2023 10AM 23°C 1PM 26°C 5-Day Forecast
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Incredible moment paralysed man walks for first time in 12 YEARS after being fitted with mind-reading implant
- Gert-Jan, 40, suffered a spinal cord injury following a bicycle accident
- New electronic implant has enabled to him to regain control over his legs again
By Shivali Best For Mailonline
Updated: 09:40 AEST, 25 May 2023
Remarkable footage has captured a paralysed man walking for the first time in 12 years — using just the power of his thoughts.
Gert-Jan Oskam, 40, from the Netherlands, suffered a devastating bicycle accident while working in China in 2011. It robbed him of his ability to move his legs.
But a pioneering electronic implant has enabled him to regain control over his legs once again.
Heart-warming footage shows Gert-Jan standing, walking, and even climbing stairs after being fitted with the mind-reading device.
Gregoire Courtine, a neuroscientist at the École Polytechnique Fédérale de Lausanne (EPFL), who worked on the study, described the ‘tremendous’ technology as a ‘digital rebirth’ of the spinal cord.
The incredible moment a paralysed man was able to walk for the first time in 12 years has been caught on camera
Gert-Jan, 40, suffered a spinal cord injury following a bicycle accident that left him paralysed. But a new electronic implant has enabled to him to regain control over his legs once again
Exoskeleton footwear enables wearer to walk 9% faster with 17% less effort – READ MORE
Created at Stanford, the robotic footwear comes with a motor that works with calf muscles to give the wearer an extra push with every step
Spinal cord injuries can interrupt the communication between the brain and the region of the spinal cord that controls walking, leading to paralysis.
Previous studies have sought to restore movement in people with this type of paralysis by electrically stimulating regions of the spinal cord.
However, this required wearing motion sensors, and patients showed limited mobility across different tasks and terrains.
Instead, the EPFL team came up with a new approach, using electronic implants to develop a ‘wireless digital bridge’ between the brain and the spinal cord.
One implant is placed in the patient’s brain, above the region responsible for leg movements.
Meanwhile, the second is placed on the region of the spinal cord that controls leg movement.
Professor Jocelyne Bloch, an author of the study, said: ‘These devices decode the electrical signals generated by the brain when we think about walking.’
The brain signals are then converted into sequences of electrical stimulation of the spinal cord.
In turn, this activates the leg muscles to achieve the desired movement.
One implant is placed in the patient’s brain (pictured), above the region responsible for leg movements, while the second is placed on the region of the spinal cord that controls leg movement
Professor Jocelyne Bloch, an author of the study, said: ‘These devices decode the electrical signals generated by the brain when we think about walking’
Signals from the brain are converted into sequences of electrical stimulation of the spinal cord. In turn, this activates the leg muscles to achieve the desired movement
Best of all, the system operates wirelessly, allowing the patient to move around independently.
After the implants had been placed in Gert-Jan’s brain and spinal cord, the system took just minutes to calibrate, and he has been able to use it at home for over a year now.
While the system has allowed Gert-Jan to stand, walk, and climb stairs on his own, he joked that the best thing he’s been able to do is stand at the bar to share a beer with his friends.
‘This simple pleasure represents a significant change in my life,’ he said.
Amazingly, even with the digital bridge switched off, the researchers have seen ‘remarkable improvements’ in Gert-Jan’s motor skills.
‘This digital repair of the spinal cord suggests that new nerve connections have developed,’ they said.
So far, the digital bridge has only been test in one person, but the team now hopes to roll it out to other people.
‘Expanding the concept of a digital bridge to the cervical spinal cord may also restore arm and hand movements after spinal cord injury and stroke,’ they concluded.
After the implants had been placed in Gert-Jan’s brain and spinal cord, the system took just minutes to calibrate, and he has been able to use it at home for over a year
While the system has allowed Gert-Jan to stand, walk, and climb stairs on his own, he joked that the best thing he’s been able to do is stand at the bar to share a beer with his friends
What are the most common causes of paralysis?
Strokes are the most common cause of paralysis, accounting for 29 per cent of all cases.
When blood supply to the brain is cut off, the organ is injured, which ‘impedes its relationship with the spinal cord’.
Together the brain and vertebrae control movement.
Spinal cord injuries make up 23 per cent of paralysis cases.
These usually occur due to car accidents, falls, sports injuries and violence.
Other common causes of paralysis include:
- Multiple sclerosis (17 per cent)
- Cerebral palsy (seven per cent)
- Post-polio syndrome (five per cent)
- Traumatic brain injury (four per cent)
- Neurofibromatosis (four per cent)
- Birth defects (two per cent)
Source: SpinalCord.com
What is the “sleepy girl mocktail”—and should you drink it?
Specialties & Diseases > Neurology
What is the “sleepy girl mocktail”—and should your patients drink it?
By Lisa Marie Basile | Fact-checked by Davi Sherman
Key Takeaways
- A new TikTok trend calls for tart cherry juice and magnesium powder in a mocktail to treat insomnia.
- The mocktail may help some fall asleep soundly, but it may not be safe for patients taking some prescription medication.
Social media apps allow countless creators and influencers to share their favorite beauty and wellness trends. From vaginal dabbing to face taping, there’s a chance your patients are either being exposed to or engaging in some trend du jour.
One of the newest? The “sleepy girl mocktail,” a drink containing sleep-inducing supplements topped off with a non-alcoholic fizzy beverage. According to BuzzFeed, the sleepy girl mocktail was originally created by TikTok user Calee Shea. Still, it gained virality after Gracie Nortion also posted her own sleepy girl mocktail on the platform.[1]
In the video by Calee Shea, tart cherry juice was poured into a glass over ice with a bit of prebiotic Olipop soda. Norton, however, added a teaspoon of magnesium powder to the glass before adding “a cup to a cup and a half” of tart cherry juice. Norton also topped it off with a bit of Olipop soda. “I got the best sleep of my life,” Norton shared.
There are other recipe variations on the Internet. Some sleepy girl mocktails are made with apple cider vinegar or sparkling water in lieu of soda.
A closer look at tart cherry juice
Tart cherry juice—made from the Montmorency cherry, which is the most popular sour cherry in the US—contains L-tryptophan, or tryptophan, which has been shown in studies to shorten waking after sleep onset.[2][3][4]
Mary Sabat MS, RDN, LD, adds that tart cherry juice also contains melatonin, which “can help regulate sleep patterns and promote restful sleep.” In fact, a small study found that tart cherry juice increased urinary melatonin content, leading to “significant increases in time in bed, total sleep time, and sleep efficiency total.” The study also found that “tart cherry juice concentrate provides an increase in exogenous melatonin that is beneficial in improving sleep duration and quality in healthy men and women and might be of benefit in managing disturbed sleep.”[5]
According to another small sleep study published in the American Journal of Therapeutics, subjects with insomnia who drank 240 mL of cherry juice twice per day for two weeks saw increased sleep time (84 minutes on polysomnography) and efficiency.[6]
Despite tart cherry juice’s potential effectiveness, a sleepy girl mocktail isn’t for everyone, says Sabat, who suggests that certain patients exercise caution when drinking tart cherry juice.
“Pure tart cherry juice is generally safe for most people when consumed in moderate amounts. However, patients with certain medical conditions, like diabetes or kidney problems, may need to exercise caution due to the sugar content in the juice.” More importantly, Sabat says, some patients could experience gastrointestinal discomfort or allergic reactions to tart cherries.
Whether your patients are drinking melatonin through tart cherry juice or using a melatonin supplement, they’ll want to know that the FDA doesn’t regulate the supplement. Therefore, there is no defined appropriate dosage. However, doses used in studies range from 0.1 to 10 mg, according to the National Library of Medicine (NLM).
“Melatonin supplements are generally considered safe for short-term use by most people,” Sabat says, “but it’s important to use them under the guidance of a healthcare professional, especially for individuals with certain medical conditions or those taking medications that could interact with melatonin.” More specifically, your pregnant or breastfeeding patients should avoid using melatonin. Exercise caution about melatonin use in patients with impaired liver function or autoimmune conditions and patients undergoing dialysis.[7]
Some people using melatonin supplements in higher doses or with extended-release formulas will experience drowsiness, daytime sleepiness, headaches, and nausea Patients should also be warned against using melatonin or drinking the sleepy girl cocktail if they are already using benzodiazepines or zolpidem, as this can cause “excessive sedation,” says the NLM.[7]
Patients should also know that melatonin can cause nightmares. In fact, some people who tried the sleepy girl mocktail reported having vivid dreams.[7]
A look at magnesium powder for sleep
Magnesium powder, the drink’s other optional ingredient, improves sleep by stimulating the parasympathetic nervous system. In a small study of elderly adults, dietary magnesium supplementation was found to “improve subjective measures of insomnia.”[8]
However, a review in BMC Complementary Medicine and Therapies found that while oral magnesium supplements taken to improve insomnia symptoms may be beneficial, the “quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia.”
“Magnesium powder is generally safe for most people when taken in appropriate doses,” Sabat adds. “However, some individuals may experience digestive issues or mild side effects such as diarrhea.” The National Institutes of Health (NIH)’s recommended daily allowances of no more than 400 and 310 mg, respectively, for adult men and women between the ages of 19 and 30, and 420 and 320 mg, respectively, for men and women aged 31 and older.
The sleepy girl mocktail could also interfere with some patients’ medications, including antibiotics, aminoglycosides, blood pressure medications, medications for diabetes, and hormone replacement therapy.[9]
What should physicians know about the sleepy girl mocktail?
While the sleepy girl mocktail may be safe for many people, Sabat says, “some individuals have specific health conditions, allergies, or sensitivities that could make certain ingredients or dosages unsuitable for them.”
Moreover, the drink might not bring on those coveted Zzzs for some people. “The overall effectiveness of any sleep aid can vary from person to person,” Sabat adds. In this case, exploring a patient’s overall sleep hygiene may be more beneficial.
An evaluation of menopause service delivery during the COVID-19 pandemic
An evaluation of menopause service delivery during the COVID-19 pandemic
Hugo Pedder https://orcid.org/0000-0002-7813-3749 hugo.pedder@bristol.ac.uk, Lynne Robinson, […], and Jo Marsden https://orcid.org/0000-0001-8452-1548+2View all authors and affiliations
Abstract
Objective
To investigate the experience of remote outpatient menopause service delivery by clinicians and patients during the COVID-19 pandemic.
Methods
Two surveys explored the experiences of patients and clinicians separately. Patients attending menopause clinics in the UK were directed to an online survey which included questions on demographics and on their experience of their most recent appointment. A clinician survey was shared to members of the British Menopause Society (BMS) via email and was made available on the BMS website. It contained questions on clinic characteristics and clinicians’ experience of delivering remote menopause consultations. Surveys were available for completion between 01/12/2020 and 10/02/2021.
Results
Of 180 patients who completed the patient survey, 52% felt remote consultations were the same or better than face-to-face consultations, and 90% of patients felt a choice between remote and face-to-face consultations should be offered. Patients overall were satisfied with many aspects of care, though numerous problems were highlighted with appointment administration. Of 76 clinicians who completed the clinician survey, most found remote patient consultations either no different or a bit worse than face-to face consultations but found that they offered more flexibility. In some cases, significant rescheduling was necessary to accommodate for the clinical needs of the consultation.
Conclusion
A ‘one-size-fits-all’ approach to managing the delivery of menopause care is not supported by patients or clinicians. There must be a robust process in place to avoid problems with appointment scheduling and associated communications. Lessons learned from the pandemic can help to provide holistic menopause care.
Key points and recommendations
Patients
• 52% felt remote consultations the same or better than face to face consultations.
• 90% of patients felt a choice between remote and face-to-face consultations should be offered.
• Patients overall were satisfied with the convenience, duration and feeling of involvement in decisions about their care.
• Satisfaction with the quality of service appeared to be higher in NHS hospital or private clinics than with GP review.
• Irrespective of whether consultations took place in primary or secondary care, there were numerous problems with appointment administration (e.g. scheduling. cancellation, waiting times).
Clinicians
• Most clinicians found remote patient consultations, which were mostly by telephone (fewer via video), either no different, or a bit worse than face-to face consultations but to offer more flexibility.
• In a small minority, however, significant rescheduling was necessary to accommodate for the clinical needs of the consultation (e.g. clinical examination, patient language and hearing difficulties).
• There is a perception that remote consultations are associated with lower DNA rates.
Recommendations/conclusions
• A ‘one-size-fits-all’ approach to managing the delivery of menopause care is not supported by patients or clinicians.
• Patient triage would enable a service tailored to medical and social need. Ideally this requires a nationally agreed consensus.
• There must be a robust process in place, with sufficient administrative support, to avoid problems with appointment scheduling and associated communications.
• Educational support for menopause management in primary care is required.
Antiaging effect of progesterone cream.
This is a blog I had a few years ago on this website. Many of my patients have been using it since then, and generally pleased with the results. It has the bonus of being properly researched, is very safe, and is proven to work. To obtain it you will need a prescription and will need a compounding chemist to make it up.
Antiaging effect of progesterone cream.
Posted by Dr Colin Holloway
I am able to give you a script for this cream when you next see me. It has worked well in those I have given it to over the last 2 years.
Br J Dermatol. 2005 Sep;153(3):626-34.
Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study.
Holzer G1, Riegler E, Hönigsmann H, Farokhnia S, Schmidt JB.
Author information
- 1Division of Special and Environmental Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. gregor.holzer@meduniwien.ac.at
Erratum in
- Br J Dermatol. 2005 Nov;153(5):1092. Schmidt, B [corrected to Schmidt, JB].
Abstract
BACKGROUND:
For many years topical progesterone has been prescribed by gynaecologists as an antiageing and skin-firming treatment, without any clinical scientific evidence of its effects, tolerability and safety when applied to skin.
OBJECTIVES:
To evaluate the influence of 2% progesterone cream on function and texture of the skin in peri- and postmenopausal women.
METHODS:
A double-blind, randomized, vehicle-controlled study was conducted in 40 subjects. Objective methods for measuring skin elasticity, epidermal hydration and skin surface lipids, clinical monitoring and self-assessment, and determination of blood hormone levels (luteinizing hormone, follicle-stimulating hormone, oestrogen and progesterone) were used to determine effects and side-effects of this treatment at four visits over a 16-week period.
RESULTS:
The study demonstrated a significant (P < or = 0.05) increase of the elastic skin properties in the treatment group, as demonstrated by objective measurements of three skin elasticity parameters, whereas in the control group no such effect was observed. This effect in the treatment group was further paralleled by the results of the clinical monitoring, where the 2% progesterone cream yielded consistent superiority over vehicle in counteracting different signs of ageing in the skin of peri- and postmenopausal women. Clinical monitoring showed a greater reduction in wrinkle counts (29.10% vs. 16.50%) and wrinkle depth (9.72% vs. 7.35%) around the right eye, a greater decrease in nasolabial wrinkle depth (9.72% vs. 6.62%) and a significantly higher (P < 0.05) increase in skin firmness (23.61% vs. 13.24%) in the treatment group. Epidermal hydration and skin surface lipids did not change significantly in either group during the study. Progesterone was well absorbed in the systemic circulation: mean blood levels rose minimally, but statistically significantly (P = 0.001), by 0.53 ng mL(-1). No serious side-effects of the treatment were observed.
CONCLUSIONS:
The results of this study demonstrate that topical 2% progesterone acts primarily in increasing elasticity and firmness in the skin of peri- and postmenopausal women. These effects in combination with good tolerability make progesterone a possible treatment agent for slowing down the ageing process of female skin after onset of the menopause.
Is face tape really the new “natural botox?”
Specialties & Diseases > Dermatology
Is face tape really the new “natural botox?”
By Lisa Marie Basile | Fact-checked by Davi Sherman
Key Takeaways
- Recent news reports and social media videos reveal that face taping has become increasingly popular. The practice involves taping areas of the face in order to reduce the appearance of wrinkles.
- There is no evidence to support the long-term efficacy of face taping, although some may see a brief change in their skin after use.
- Experts agree that this practice may pose particular risks to the skin. To avoid these risks, other procedures are recommended.
TikTok is full of videos from content creators claiming that face taping has helped them look younger. In fact, videos related to the search term “face tape” have generated an estimated 565 million views on the social media app. The practice has even been referred to as “natural botox” by one social media user, according to a news report.
Face taping involves placing individual pieces of tape over areas such as glabellar lines or the nasolabial folds and then going to sleep with the tape in place. Another method of face taping includes taking two pieces of tape—which have strings attached to them—and placing the taping near your temples. With this method, you’ll pull the strings and tie them behind your head so that your skin is pulled tightly. Enthusiasts report waking up with less prominent wrinkles.
It isn’t just TikTok spreading the idea of face taping. Brands selling face tape claim that it has benefits as well. For example, Kinesiology Sports Tape, a self-described “wellness sports brand,” says that its face tape products offer a “safe, non-invasive anti-aging lifting method used to reduce facial swelling and wrinkles.”[1]
So, if your patients ask about face taping as a means of staving off the realities of aging, here’s what the evidence and experts say.
What is behind the idea of face taping?
Face taping is nothing new, says Joshua A. Lampert, MD, a board-certified aesthetic and reconstructive plastic surgeon. In fact, face tape may have appeared on the market in 1889, as it was used by stage performers in a bid to hide their wrinkles.[2] Later, during the Golden Age of Hollywood, stars would use face tape to reduce the appearance of wrinkles. Traditionally, the tape would be hidden under their wigs or hair.
So does it work? There are no clinical studies confirming the efficacy of face taping. Its effects—if any—are also brief. “It provides only a temporary solution,” Lampert says. In the immediate or very short term, “face taping can be used to block the patient’s ability to animate the facial muscles of expression. This can give the patient a transient resting facial expression, which appears less wrinkled for a short period of time.”
While one study did show that use of lymphatic kinesio face taping improved blood and lymph microcirculation in patients who had undergone orthognathic surgery, this study involved surgical patients, not those who tape their faces before bed or for a few hours.[3]
Given the relatively short-lived benefits that face taping might offer, experts stress that it’s not a form of “natural botox” and that it cannot make permanent changes to the skin, especially since wrinkles are associated with a variety of factors, including aging, hormones, disease, smoking status, and sun exposure.[4]
According to Cameron Rokhsar, MD, FAAD, FAACS, a double board-certified dermatologist and laser and MOHS surgeon, “[Face taping] doesn’t address the underlying cause of wrinkles, which is the breakdown of collagen and elastin in the skin over time. Wrinkles caused by muscle movement are known as dynamic wrinkles, [which occur] when the same facial expressions are made repeatedly over time, causing lines to become more deeply etched into the skin,” he says. “Face taping does not prevent this movement and therefore cannot prevent the formation of these types of wrinkles.”
Kinds of tape used in face taping
Content creators across TikTok seem to utilize all sorts of tape, from everyday Scotch tape to Invisitape products specifically designed to offer a ‘face-lift’ effect. Many face taping enthusiasts also use kinesiology tape (KT)—which was created in the 1970s and made to address several health concerns, ranging from musculoskeletal pain to sports injuries.
KT itself is widely used but isn’t necessarily a proven therapeutic tool for many of its medical uses, however. According to a 2021 review in the International Journal of Sports Physical Therapy, which assessed 38 studies and used data from a small survey to assess KT’s therapeutic qualities, the research around the product’s therapeutic efficacy is inconclusive: “Despite the popularity [of kinesiology tape], the research regarding KT therapeutic benefits is inconclusive with many studies reporting inconsistent outcomes,” the authors wrote.[5]
Experts suggest patients skip face taping
Your patients should know that there are some risks involved in face taping; Lampert says: “Tape adhesives can lead to rashes and skin allergies and breakouts. Excessive use could potentially result in adhesive-related excoriations, skin injury, blisters, scarring, or melasma, though these are uncommon.”
But beyond avoiding any risks, patients simply have better options, says Rokhsar.
“For moderate wrinkles, non-ablative lasers or photodynamic rejuvenation may be effective. Non-ablative lasers (like Fraxel) work by stimulating collagen production to improve skin elasticity. Photodynamic rejuvenation uses a photosensitizing agent and light therapy to target fine wrinkles caused by sun exposure,” Rokhsar says.
For more severe wrinkles, Rokhsar recommends chemical peels (which remove the outer layer of skin) or CO2 resurfacing (which removes damaged skin cells and promotes collagen production), which may be more appealing for people who seek minimally-invasive procedures.
“For more significant laxity, there is often no alternative equal to surgery with a board-certified plastic surgeon,” Lampert adds.
Talking to patients about social media trends
Rokhsar says that he has seen firsthand the impact that social media has had on patients. “Many come in seeking treatments that they have seen advertised on social media or heard about from influencers without fully understanding the risks and limitations of these procedures. Oftentimes, people who go for quick fixes are disappointed,” he says.
Because of this, he suggests talking openly with patients so that they don’t waste their time or money on procedures that don’t provide the results they’re looking for. Additionally, it’s always important to remind patients to consult with a board-certified dermatologist before undergoing any cosmetic treatments or procedures, he says. In experienced hands, he adds, even noninvasive procedures like non-ablative laser resurfacing can lead to permanent scarring.
Lampert agrees. “Social media can be a great educational tool, but it can also lead potential patients down the wrong path,” he says—which is why you should be in open dialogue with your patients about it.
“Having a large number of followers on social media is no substitute for adequate training, experience, credentialing, and certification. [So,] I encourage my patients to discuss any trends and their validity with me,” Lampert stresses.
4 best spices for arthritis
I have been taking cinnamon(1/2 teaspoon in a little hot water and a teaspoon of honey), Turmeric with ginger and black pepper(https://turmericaustralia.com.au/), and aged Kyolic Garlic(iHerb) for many years. I have also been taking 10 thousand mg Fish oil capsules daily for over 20 years. . Thankfully I have very healthy joints and am totally pain free. Maybe that is a result of taking these.
4 best spices for arthritis
Spices not only increase the flavour and aroma of the foods we eat, they may also lessen symptoms of arthritis by inhibiting specific pathways that can lead to inflammation. Next time you are in the kitchen, try to incorporate these savory, anti-inflammatory spices.
1. Garlic
Garlic has traditionally been used as an antidote for disease. It belongs to the genus allium and contains an anti-inflammatory compound known as diallyl disulphide. Allium vegetables include garlic, onion leeks, chives and scallions.
A long-term study showed that women whose diets were rich in allium vegetables, such as garlic, had lower levels of osteoarthritis. Other studies have shown its effect on reducing inflammation, pain and fatigue associated with rheumatoid arthritis.
How to use it: Garlic can be consumed either raw or cooked. In its raw form, garlic is more pungent, spicy and earthy. Peel and grate fresh garlic over cooked vegetables, soup, salad, pasta or a couple slices of toast. To combat “garlic breath,” consume a few drops of freshly squeezed lemon or brush your teeth. Cooked garlic has a mild nutty taste. Add garlic to stews, pasta, mashed potatoes, soup and roasted vegetables.
Tip: Consider roasted garlic and olive oil as a spread on bread instead of butter. Looking for a fulsome meal idea with garlic? Try Chef Vikram Vij’s Yogurt and tamarind marinated grilled chicken.
2. Ginger
Ginger has been used as folk medicine for centuries. Gingerol is the main anti-inflammatory compound in ginger. It functions similarly to COX-2 inhibitors, which are drugs used to treat joint pain and inflammation. Some studies have linked ginger to decreased joint pain and disability in people with osteoarthritis.
How to use it: Ginger has an unmistakable sharp and aromatic flavour. It elevates any dish when added. It can be challenging to use due to its stringy texture, however. A simple way to prevent this and ensure your ginger stays fresh is to freeze the ginger root. This allows you to grate the ginger easily into a variety of dishes including stews, rice, fruit sauces, muffins and more.
Tip: Add a piece of ginger to your fruit smoothie for a delicious, aromatic and anti-inflammatory boost, like in our Ginger blueberry smoothie.
3. Cinnamon
Once so valuable and rare, cinnamon was often given as gifts to kings. Cinnamon contains chemical compounds known as cinnamaldehyde and cinnamic acid.
These compounds have been associated with reducing joint pain. Research has shown some promising results with cinnamon supplementation in reducing inflammation and oxidative stress.
How to use it: One small study involving women with rheumatoid arthritis showed taking cinnamon powder supplements reduced levels of inflammation. More studies are needed to fully determine the effectiveness of cinnamon and its impact on inflammation. However, there is no harm in generously using this spice to flavour food.
Tip: Create a savoury Moroccan-inspired dish by adding cinnamon along with raisins and cashews to couscous or rice, or try our delicious Cinnamon power waffles.
4. Turmeric
Best known for its vibrant rich yellow colour, turmeric is a spice commonly used in Indian cuisine. It has a long history of being used as medicine in Chinese and Indian cultures as well. Turmeric contains a compound known as curcumin. This compound gives turmeric its bright yellow colour and is also associated with lowering inflammation and easing osteoarthritis pain.
How to use it: One study suggested curcumin supplementation was almost as effective as non-steroidal anti-inflammatory drugs (NSAIDS) in reducing osteoarthritis pain. Another study showed curcumin played a role in preventing bone breakdown in people with rheumatoid arthritis. Reports show that curcumin should be paired alongside black pepper. The active compound in pepper, piperine, can increase the absorption of curcumin.
More research is needed to determine the safety and effectiveness of curcumin supplementation. Gastrointestinal problems have also been associated with long-term use, so use it mindfully.
Tip: Whisk turmeric and black pepper into your favourite salad dressing and drizzle onto your roasted vegetables or salad, or try our Turmeric-infused beef and barley soup.
Written by Lalitha Taylor, registered dietitian.
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The Link Between Highly Processed Foods and Brain Health
The Link Between Highly Processed Foods and Brain Health
Eating packaged foods like cereal and frozen meals has been associated with anxiety, depression and cognitive decline. Scientists are still piecing together why.
By Sally Wadyka
May 4, 2023, 5:00 a.m. ET
Roughly 60 percent of the calories in the average American diet come from highly processed foods. We’ve known for decades that eating such packaged products — like some breakfast cereals, snack bars, frozen meals and virtually all packaged sweets, among many other things — is linked to unwelcome health outcomes, like an increased risk of diabetes, obesity and even cancer. But more recent studies point to another major downside to these often delicious, always convenient foods: They appear to have a significant impact on our minds, too.
Research from the past ten or so years has shown that the more ultraprocessed foods a person eats, the higher the chances that they feel depressed and anxious. A few studies have suggested a link between eating UPFs and increased risk of cognitive decline.
What’s so insidious about these foods, and how can you avoid the mental fallout? Scientists are still working on answers, but here’s what we know so far.
What qualifies as an ultraprocessed food?
In 2009, Brazilian researchers put food on a four-part scale, from unprocessed and minimally processed (like fruits, vegetables, rice and flour) to processed (oils, butter, sugar, dairy products, some canned foods, and smoked meats and fish) and ultraprocessed. “Ultraprocessed foods include ingredients that are rarely used in homemade recipes — such as high-fructose corn syrup, hydrogenated oils, protein isolates and chemical additives” like colors, artificial flavors, sweeteners, emulsifiers and preservatives, said Eurídice Martínez Steele, a researcher in food processing at University of Sao Paulo, Brazil. This classification system is now used widely by nutrition researchers.y
UPFs make up a majority of the packaged foods you find in the frozen food aisles at grocery stores and on the menu at fast-food restaurants — 70 percent of the packaged foods sold in the United States are considered ultraprocessed. They’re increasingly edging out healthier foods in people’s diets and are widely consumed across socioeconomic groups.
“Ultraprocessed foods are carefully formulated to be so palatable and satisfying that they’re almost addictive,” said Dr. Eric M. Hecht, an epidemiologist at the Schmidt College of Medicine at Florida Atlantic University. “The problem is that in order to make the products taste better and better, manufacturers make them less and less like real food.”
What effect do ultraprocessed foods have on mental health?
Recent research has demonstrated a link between highly processed foods and low mood. In one 2022 study of over 10,000 adults in the United States, the more UPFs participants ate, the more likely they were to report mild depression or feelings of anxiety. “There was a significant increase in mentally unhealthy days for those eating 60 percent or more of their calories from UPFs,” Dr. Hecht, the study’s author, said. “This is not proof of causation, but we can say that there seems to be an association.”
New research has also found a connection between high UPF consumption and cognitive decline. A 2022 study that followed nearly 11,000 Brazilian adults over a decade found a correlation between eating ultraprocessed foods and worse cognitive function (the ability to learn, remember, reason and solve problems). “While we have a natural decline in these abilities with age, we saw that this decline accelerated by 28 percent in people who consume more than 20 percent of their calories from UPFs,” said Natalia Gomes Goncalves, a professor at the University of São Paulo Medical School and the lead author of the study.
It’s possible that eating a healthy diet may offset the detrimental effects of eating ultraprocessed foods. The Brazilian researchers found that following a healthy eating regimen, like the MIND diet — which is rich in whole grains, green leafy vegetables, legumes, nuts, berries, fish, chicken and olive oil — greatly reduced the dementia risk associated with consuming ultraprocessed foods. Those who followed the MIND diet but still ate UPFs “had no association between UPF consumption and cognitive decline,” Dr. Goncalves said, adding that researchers still don’t know what a safe quantity of UPFs is.
Why might ultraprocessed foods have this effect?
It’s unclear. “Many high-quality, randomized studies have shown the beneficial effect of a nutrient-dense diet on depression, but we still do not fully understand the role of food processing on mental health,” said Melissa Lane, a researcher at the Food & Mood Centre at Deakin University in Australia. However, there are some clues.
Much of the research has focused on how poor gut health might affect the brain. Diets that are high in ultraprocessed foods are typically low in fiber, which is mostly found in plant-based foods like whole grains, fruits, vegetables, nuts and seeds. Fiber helps feed the good bacteria in the gut. Fiber is also necessary for the production of short-chain fatty acids, the substances produced when it breaks down in the digestive system, and which play an important role in brain function, said Wolfgang Marx, the president of the International Society for Nutritional Psychiatry Research and a senior research fellow at Deakin University. “We know that people with depression and other mental disorders have a less diverse composition of gut bacteria and fewer short-chain fatty acids.”
Chemical additives in UPFs might also have an impact on gut flora. “Emerging evidence — mostly from animal studies, but also some human data — suggests that isolated nutrients (like fructose), additives such as artificial sweeteners (like aspartame and saccharin) or emulsifiers (like carboxymethylcellulose and polysorbate-80) can negatively influence the gut microbiome,” Dr. Marx said.
Poor gut microbiota diversity — as well as a diet high in sugar — may contribute to chronic inflammation, which has been linked to a host of mental and physical issues, Dr. Lane said. “Interactions between increased inflammation and the brain are thought to drive the development of depression,” she said.
It’s also worth considering the possibility that the link between highly processed foods and mental health works in both directions. “Diet does influence mood, but the reverse is also true,” said Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. “When you get stressed, anxious or depressed, you tend to eat more unhealthy foods, in particular ultraprocessed foods that are high in sugar, fat and chemical additives.”
How to recognize ultraprocessed foods
The best way to identify ultraprocessed foods is to read product labels. “A long list of ingredients, and especially one that includes ingredients you would never use in home cooking,” are clues that the food is ultraprocessed, said Whitney Linsenmeyer, an assistant professor of nutrition at Saint Louis University in Missouri and a spokeswoman for the Academy of Nutrition and Dietetics. Chemical names, unpronounceable words, and anything you would be unlikely to find in a kitchen cabinet are often signs that a food is in the ultraprocessed category.
You can still use convenience foods to make cooking easier without resorting to ultraprocessed foods. Products such as canned beans, frozen vegetables, precooked brown rice or canned fish are all shortcut ingredients that fit well within the scope of a healthy diet, provided there aren’t any industrial items on the ingredient list. “If the added ingredients are ones you would use yourself, like herbs, spices, salt or cooking oils,” Dr. Linsenmeyer said, “that’s an indication that the food, while processed, is not inherently bad for you.”
Dr Colin Holloway 
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