tag:theconversation.com,2011:/id/topics/womens-health-31225/articlesWomen's health – The Conversation2024-03-28T12:21:11Ztag:theconversation.com,2011:article/2243222024-03-28T12:21:11Z2024-03-28T12:21:11ZWhy women’s rugby needs its own injury prevention strategy<p>With the Women’s Six Nation’s Championship underway, there is <a href="https://www.bbc.co.uk/sport/rugby-union/65129693">mounting public concern</a> regarding the <a href="https://www.rugbypass.com/news/long-term-brain-damage-could-be-a-significantly-bigger-issue-in-womens-rugby-than-mens-says-lead-concussion-doctor/">risk of injuries</a> to players. </p>
<p>In recent years there has been a significant rise in the number of women playing rugby. Women now make up <a href="https://www.rugbyworldcup.com/2023/news/836825/global-rugby-participation-increasing-ahead-of-rugby-world-cup-2023">one-quarter</a> of the global rugby playing population. But despite the fact that there are similar injuries in both men and women’s rugby, female players need their own injury prevention strategy. </p>
<p>There is evidence to suggest that gender differences may <a href="https://pubmed.ncbi.nlm.nih.gov/34052518/">influence injuries</a> in team sports in general. </p>
<p>Research shows that lower neck strength may predispose female rugby players <a href="https://pubmed.ncbi.nlm.nih.gov/34463209/">to concussion</a>. Research has shown that females have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582549/">greater head acceleration</a> in response to an applied force than males, which could predispose them to concussion. This may be because females have significantly less isometric neck strength and neck girth. </p>
<p>Anatomical differences in the female pelvis, knee and lower leg can alter lower limb alignment. The resulting <a href="https://www.physio-pedia.com/Valgus_Knee">knee valgus</a>, or “knock knee”, may <a href="https://my.clevelandclinic.org/health/body/24777-knee-joint">increase injury risk</a> to the knee particularly the medial collateral ligament, meniscus and possibly the anterior cruciate ligament (ACL). </p>
<p>Gender differences in <a href="https://www.britannica.com/science/neuromuscular-junction">neuromuscular function</a> (the communication between the brain and muscles) have also been reported to contribute to <a href="https://pubmed.ncbi.nlm.nih.gov/8775118/">ACL injury</a> and possibly <a href="https://pubmed.ncbi.nlm.nih.gov/31092121/">concussion</a>. </p>
<p>While there are such differences, the common types of injuries in male and female rugby are similar. Concussion tops the list as the most common specific injury diagnosis with lower leg injuries to the ankle, knee and hamstring following behind. </p>
<h2>Higher risk?</h2>
<p>Within rugby union, an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659070/">injury is defined</a> as any physical complaint sustained by a player during the game that results in the player being unable to take part in future rugby activities. </p>
<p>At the elite level, <a href="https://www.englandrugby.com/dxdam/d8/d86ddce6-f7d0-4aeb-9897-34ecaed2565d/WRISP_report_20-21.pdf">women’s rugby</a> has an overall injury risk that is nearly 50% lower than <a href="https://keepyourbootson.co.uk/wp-content/uploads/2022/03/PRISP-report-2021-22.pdf">men’s rugby</a>. This equates to about three injuries in every male professional match, and less than two injuries in every women’s rugby match. </p>
<p>In amateur rugby, the landscape is different. Both male and female players face a <a href="https://pubmed.ncbi.nlm.nih.gov/33655802/">comparable risk of injury</a>, albeit a lower overall risk than at the professional level. </p>
<p>Emerging evidence also suggests that the overall burden of injury may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558996/">higher in females than males</a> at this level. Injury burden is a composite measure of injury incidence, or rate, and the days missed that is used by experts to understand the overall impact of injuries.</p>
<h2>Concussion and ACL injuries</h2>
<p><a href="https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594#:%7E:text=A%20concussion%20is%20a%20mild,a%20change%20in%20brain%20function">Concussion</a> is a mild traumatic brain injury, usually caused by an impact to the head or body. The rate of concussion in <a href="https://keepyourbootson.co.uk/wp-content/uploads/2022/03/PRISP-report-2021-22.pdf">men’s professional rugby</a> is more than 30% higher than in <a href="https://www.englandrugby.com/dxdam/d8/d86ddce6-f7d0-4aeb-9897-34ecaed2565d/WRISP_report_20-21.pdf">women’s rugby</a>. Research is limited on this topic, but it could be because of the increased size and speed in male rugby increasing the force of contact to the body and therefore also to the head and neck.</p>
<p>However, gender differences in overall injury risk means that concussion accounts for more than one-third of all injuries for women and less than a quarter of injuries for men. </p>
<p>Also notable is that female players face more adverse consequences than men <a href="https://bjsm.bmj.com/content/57/4/212#ref-21">following concussions</a>, such as double the recovery time. The <a href="https://doi.org/10.1080/17461391.2021.1973573">cause</a> of concussion should also be considered. Whiplash and head to ground contact are substantial factors in female players, and more so than in men. This is due to lower isometric neck strength meaning less control of the head during a tackle.</p>
<p>ACL injuries also plague <a href="https://news.griffith.edu.au/2023/05/25/revolutionising-acl-research-and-recovery-for-female-athletes-will-be-bournes-legacy/">elite women’s soccer</a>. But in elite rugby, they are 20 times higher <a href="https://pubmed.ncbi.nlm.nih.gov/17293461/">for male</a> professional rugby players than their <a href="https://pubmed.ncbi.nlm.nih.gov/36428090/">female counterparts</a>. </p>
<p>Looking at the lower tiers of rugby, it becomes clear that women face a five times higher rate of ACL injuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899911/">compared to men</a>. Similar to concussion, ACL injuries represent a greater injury burden <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558996/#:%7E:text=Anterior%20cruciate%20ligament%20injuries%20presented,fourth%20quarter%20of%20match%20play">for women</a> in comparison to men with 50% longer recovery times.</p>
<h2>Unanswered questions</h2>
<p>Many questions remain to be answered on female rugby injury. For example, as women’s rugby transitions towards professionalism, how will this affect injury risk? </p>
<p>The lack of elite female teams has possibly contributed to women taking up the sport at an older age than men. This may explain the emerging evidence of a link between poorer tackle technique and higher injury risk in female players. </p>
<p>There are many other factors we need to understand better too. For example, does the greater injury burden, often reported in women’s rugby, stem from a lack of adequate medical support for female teams? And is the menstrual cycle related to <a href="https://pubmed.ncbi.nlm.nih.gov/37391203/">sports injury?</a></p>
<p>We also need to better understand breast injuries. These injuries are prevalent in <a href="https://pubmed.ncbi.nlm.nih.gov/29322119/">other sports</a> such as basketball, soccer, softball and volleyball. Nearly half of female athletes in such sports have reported they have sustained a breast injury. But there is very limited research or established guidelines concerning breast protection and breast health in women’s rugby. </p>
<p>Despite these unanswered questions, what is clear is that when it comes to playing contact sports, women cannot be viewed simply as smaller versions of men. Instead of imposing male injury prevention strategies on women’s rugby, it would be more beneficial to redirect attention towards understanding the specific injury risks in the women’s game. Then we can develop tailored injury prevention strategies for female players.</p><img src="https://counter.theconversation.com/content/224322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Owen receives funding from World Rugby. </span></em></p><p class="fine-print"><em><span>Eloise Kirby receives funding from World Rugby. </span></em></p>Despite the fact that there are similar injuries in men and women’s rugby, women should not be viewed merely as smaller versions of men.Julian Owen, Lecturer in Sport & Exercise Physiology, Bangor UniversityEloise Kirby, PhD Candidate, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2259702024-03-27T17:06:46Z2024-03-27T17:06:46ZTikTok health hacks promising to change the taste and smell of female genitals are more sour than sweet<figure><img src="https://images.theconversation.com/files/583701/original/file-20240322-18-w5sur7.jpg?ixlib=rb-1.1.0&rect=25%2C12%2C8456%2C5633&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/top-view-slim-woman-tanned-skin-1037808799">Cast Of Thousands/Shutterstock</a></span></figcaption></figure><p>Wake up. Brush teeth. Exfoliate. Drink a glass of pineapple “coochie juice”? </p>
<p>That’s the advice from the latest viral trend on TikTok claiming to help women alter the smell and taste of their vulva and vagina. </p>
<p>A wave of short videos on the social media platform suggest strategies, including consuming large amounts of pineapple and banana, to make vaginas smell and taste sweeter. </p>
<p>One video suggests a home-brewed pineapple concoction taken three times daily for “vagina cleansing” and to make the vulva “smell good” will have benefits such as a “tighter”, “sweeter” vagina. </p>
<p>But what are we to make of these claims? Is “coochie juice” beneficial for women’s intimate health or is this a potentially harmful trend?</p>
<p>The social media videos cite various reasons for consuming pineapple for intimate hygiene. </p>
<p>These include claims that the bromelain and vitamins contained in pineapples, their high natural sugar content and acidity will improve the smell or taste of the vulva. </p>
<p>There is some <a href="https://www.sciencedirect.com/science/article/abs/pii/S1090513816301933">evidence</a> that diet can influence body odour, but only as far as male sweat is concerned. There is no evidence that eating large amounts of fruits like pineapple or banana will significantly change the smell or taste of a vulva.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/COL_BG7SQSM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Products claiming to change the taste and smell of the vagina and vulva are usually given short shrift by medical professionals.</span></figcaption>
</figure>
<p>Some prominent gynaecologists and <a href="https://www.hachette.co.uk/titles/dr-jennifer-gunter/the-vagina-bible/9780349421742/">experts have challenged</a> this fruity hack because part of the natural scent of the vulva is caused by healthy bacteria called lactobacilli. Ultimately, this hack is backed only by anecdotal evidence. </p>
<p>The TikTok health hack landscape is varied. Many videos suggest consuming pineapple as an alternative to known harmful practices, such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hsr2.1882">vaginal douching</a>, while other educated professionals create myth-busting content around the topic, such as this <a href="https://vm.tiktok.com/ZGe5Lv5UA/">response video</a>. </p>
<p>However, we should be paying attention to the way information about health and our bodies is spread on social media, as it can lack important information.</p>
<p>The quick and snappy content TikTok pioneers may lack the necessary nuance needed to talk about health and the nature of evidence. </p>
<p>One example, from an influencer who sells a variety of homemade organic enhancement treatments related to women’s insecurities – and who has 225,000 TikTok followers – demonstrates this. In her nine-second video, she dances while holding a pineapple, and urges followers to: “Stop using intimate wash for a clean vagina. Try pineapple juice to clear all fishy smells in your cookie.” </p>
<p>However, in several comments, viewers ask “how”, as the video doesn’t specify if pineapple should be taken orally or applied to the area. This shows the problems that can be created when influencers try to create the short content favoured by the TikTok algorithms and miss important clarifications or evidence to support their claims. </p>
<h2>Why are fruit vagina hacks so popular?</h2>
<p>So why does content like this vulva hack go viral? </p>
<p>In the fast-paced world of social media, content creators are constantly under pressure to <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003175605-53/precarity-discrimination-visibility-zo%C3%AB-glatt">stay visible</a> and keep their <a href="https://journals.sagepub.com/doi/10.1177/1461444818815684">content popping up</a> on your feed. This digital rat race, driven by <a href="https://journals.sagepub.com/doi/10.1177/2056305119879995">complex algorithms</a> that decide what you see, forces them to keep producing new material. </p>
<p>The catch? </p>
<p>They might find themselves scraping the bottom of the barrel for ideas, jumping onto any passing trend, even if it is questionable.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Z21lRmobRPY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Kourtney Kardashian’s vaginal health gummies were heavily criticised by medical professionals in 2023 but still went viral on social media.</span></figcaption>
</figure>
<p>The quest to stay relevant in an environment where being visible is essential, pushes influencers to create constant content, sometimes at the cost of quality and accuracy. </p>
<p>Across the social media sphere, the line between genuine health advice and misleading information is increasingly blurry. </p>
<p>Content creators claiming to be experts can misrepresent their knowledge, often by blurring the boundaries between science and pseudoscience. </p>
<p>In the case of the pineapple hack, we can see holistic and herbalist influencers using these tactics to boost their own credibility while casting doubt on conventional medicine. </p>
<p>This muddies the waters for the audience, making it difficult to distinguish fact from fiction and potentially breeding long-term scepticism of proven scientific methods in healthcare in their audiences. </p>
<p>Although social media can be a valuable space offering a wealth of benefits, including increased <a href="https://www.tandfonline.com/doi/abs/10.1080/14680777.2024.2320684">health awareness</a> and peer support, it’s crucial to remain vigilant about its potential harms. </p>
<p>One such harm can be found at the heart of this particular TikTok trend. By perpetuating stereotyped societal messages that vulvas are unpleasant and have a bad smell, trends like the pineapple hack risk creating paranoia and body image issues for those who have a vagina.</p>
<p>Suggesting that the natural biology of genitals be “hacked” fuels unrealistic expectations of the appearance and smell of vulvas and ignores the diversity and complexity of women’s bodies. </p>
<p>The trend, although seemingly jovial and harmless, reinforces a narrow and harmful view of female anatomy, which could lead to the pursuit of unhealthy practices. </p>
<p>Given the flurry of viral health trends, it’s essential to look at the information we consume on social media with a critical eye, especially when they may affect our health and wellbeing, and understand the importance of evidence in making informed health decisions.</p><img src="https://counter.theconversation.com/content/225970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Garwood-Cross 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.</span></em></p>Can eating lots of pineapple change the smell and taste of the vulva and vagina? An expert examines the latest fruity vaginal health hack.Lisa Garwood-Cross, University Fellow in Digital Health & Society, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242002024-03-11T18:04:30Z2024-03-11T18:04:30ZSocial media continues to censor women’s health posts as pornography – and it may cause serious harm<figure><img src="https://images.theconversation.com/files/580187/original/file-20240306-16-az1iju.jpg?ixlib=rb-1.1.0&rect=24%2C16%2C5492%2C3656&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media users aren't used to seeing this -- men's nipples and even pubic hair aren't censored but posts about women's bodies are assumed to be pornographic</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-nipple-inscription-censored-1170135442">Sergiy Nigeruk/Shutterstock</a></span></figcaption></figure><p>What’s the difference between men’s nipples and women’s? How about men’s pubic hair and women’s? </p>
<p>Well, on social media, at least, the difference seems to be that women’s nipples and pubic hair are considered pornographic and <a href="https://www.thetimes.co.uk/article/social-media-sites-censor-womens-health-posts-as-pornographic-w0nhjmtl7">subject to censorship</a> – no matter what the context. Even if it’s a social media post about health issues, such as periods and breast cancer.</p>
<p>Over the last few years, there have been numerous reports of censorship of women’s posts about issues <a href="https://www.washingtonpost.com/politics/2023/07/17/meta-rejected-dozens-womens-health-ads-democrats-want-answers/">from sexual health</a> to breastfeeding and cesarean sections. </p>
<p>This is sad, but not surprising: women’s bodies are often perceived as <a href="https://www.nature.com/articles/s44159-023-00192-x">sexual</a>, regardless of circumstances. </p>
<h2>Breast campaigns classified as porn</h2>
<p>There’s something particularly shocking about treating a breast cancer awareness campaign as pornography. Think about how the <a href="https://ascopubs.org/doi/10.1200/JCO.2017.76.3318">woman sees her</a> breast in that moment. She is worried that she may have a life threatening disease. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9368609/">She is concerned</a> about her health. </p>
<p>The labelling her image as pornography overrides the woman’s own view of her body and replaces it with an outsider’s view. It treats her body as an object for the sexual pleasure of the viewer. Feminists call this <a href="https://plato.stanford.edu/entries/feminism-objectification/">sexual objectification</a>.</p>
<figure>
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<figcaption><span class="caption">It’s not the first time a social media giant has allegedly banned posts relating to women’s health.</span></figcaption>
</figure>
<p>In the case of the breast cancer awareness campaign, the clash between the woman’s perspective of her body and pornography classification is stark. This makes it easier to see what is going wrong. </p>
<p>Sometimes it can be more difficult to recognise objectification. </p>
<p>Consider, for instance, the <a href="https://journals.sagepub.com/doi/abs/10.1177/0890334416648934">improvement in attitudes</a> towards breastfeeding in public. </p>
<p>In a 2015 <a href="https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/breastfeeding-in-public/">Start for Life poll</a>, 72% of people said they supported breastfeeding in public. </p>
<p>Nonetheless, some people still see <a href="https://www.swansea.ac.uk/press-office/news-events/news/2022/08/new-study-reveals-the-public-make-it-more-difficult-for-women-to-breastfeed-.php">breastfeeding as sexual</a> and research from 2022 shows that this perception continues to deter some mothers from breastfeeding in public. Again, this involves prioritising how a viewer may see women’s bodies over the woman’s own attitudes and aims.</p>
<p>However, as social media censorship shows, there’s still significant stigma around women’s bodies – and it’s harmful. </p>
<p>Researchers have explored the effects of objectification on women’s <a href="https://wp.nyu.edu/steinhardt-appsych_opus/the-effects-of-sexual-objectification-on-womens-mental-health/#:%7E:text=Sexual%20objectification%20occurs%20when%20a,Fredrickson%20%26%20Roberts%2C%201997">mental health</a>. Studies have found that women may begin to view their own bodies primarily as objects for the use of others, and to see themselves as failures if they do not match up to whatever is currently regarded as the “ideal” body shape. <a href="https://psycnet.apa.org/record/2020-59636-001">Common effects</a> include shame, anxiety, depression, disordered eating and reduced productivity. </p>
<h2>‘Vagina’ and ‘vulva’ are dirty words</h2>
<p>This view that women’s bodies are sexual regardless of context is so dominant that the algorithm does not recognise alternative reasons for talking about or showing women’s bodies. The algorithm does not recognise that content about women’s bodies may be aimed at women. Women thus lose out on the opportunity to talk about their own bodies or to find out information about their bodies. </p>
<figure>
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<figcaption><span class="caption">A medical tattooist who draws nipples on women who have lost them due to mastectomies, protested outside Facebook HQ after being blocked on social media because her work was mistaken for pornography.</span></figcaption>
</figure>
<p>In 2023, <a href="https://metro.co.uk/video/bodyform-advert-vaginas-uncensored-40-words-say-2962611/?ito=vjs-link">a campaign</a> from period products brand Bodyform was muted <a href="https://www.telegraph.co.uk/news/2023/06/08/facebook-removes-sanitary-towel-ad-for-saying-vagina/">by social media</a> for “sexual content”. </p>
<p>The campaign didn’t feature any nakedness but did include the correct anatomical terms for women’s body parts, including “vagina” and “vulva”. In response to being shadow-banned, the brand went on <a href="https://www.bodyform.co.uk/break-taboos/our-campaigns/vagina-uncensored/">to highlight</a> a list of forty words relating to women’s health that are regularly censored on social media – the list includes “clitoris”, “discharge”, “menopause”, “miscarriage” and “polycystic ovary syndrome”.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CvRkr5WMLVb/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>In 2022, the <a href="https://www.intimacyjustice.org/">Center for Intimacy Justice</a> studied 60 women’s health companies and found all of their ads were rejected on both Meta and Instagram over the previous three years, with almost half of those companies having their accounts suspended during the period. But in several instances, the ad policies only penalised content related to women and nonbinary people’s sexual health, while men’s sexual wellness brands were approved. </p>
<p><a href="https://time.com/6552430/body-reflexivity-unshrinking-kate-manne/">Philosopher Kate Manne argues</a> that even when we push back against the shame many women feel about their bodies, we often end up unintentionally entrenching the idea that women’s body exist for others. </p>
<p>Body positivity is the idea that you should see your body as beautiful no matter what shape it is. Body neutrality suggests that we should aim to feel neutral about how our bodies look. Manne offers instead body reflexivity: my body is for me, and my perspective on it is the only one that matters. </p>
<p>It may seem obvious that my body is for me. But women grow up being told in so many subtle ways that there body is primary an object for others. Against that background, body reflexivity is a radical idea.</p><img src="https://counter.theconversation.com/content/224200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Woollard was part of the Better Understanding the Metaphysics of Pregnancy (BUMP) project funded by European Research Council. She has also received funding from the Arts and Humanities Research Council; the Economic and Social Research Council (through the University of Southampton ESRC Impact Acceleration Account); the Southampton Ethics Centre and the Mind Association.
She is an ordinary member of the Labour Party as a private citizen.</span></em></p>Women’s bodies are sexually objectified no matter what the context – and it’s a serious health issueFiona Woollard, Professor of Philosophy, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2251262024-03-11T12:24:14Z2024-03-11T12:24:14ZI’m a political scientist, and the Alabama Supreme Court’s IVF ruling turned me into a reproductive-rights refugee<figure><img src="https://images.theconversation.com/files/580509/original/file-20240307-26-mc43ro.jpg?ixlib=rb-1.1.0&rect=1095%2C1199%2C1403%2C1892&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spencer and Gabby Goidel hadn't planned to become activists.</span> <span class="attribution"><span class="source">Spencer and Gabby Goidel</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The day before the Alabama Supreme Court ruled that <a href="https://apnews.com/article/alabama-supreme-court-from-embryos-161390f0758b04a7638e2ddea20df7ca">frozen embryos created and used for in vitro fertilization</a> are children, my wife, Gabby, and I were greenlighted by our doctors to begin the IVF process. We live in Alabama.</p>
<p>That Friday evening, Feb. 16, 2024, unaware of the ruling, Gabby started taking her stimulation medications, worth roughly US$4,000 in total. We didn’t hear about the decision until Sunday morning, Feb. 18. By then, she had taken four injections – or two doses – of each of the stimulation medications.</p>
<p>For those who don’t know, the <a href="https://theconversation.com/what-is-ivf-a-nurse-explains-the-evolving-science-and-legality-of-in-vitro-fertilization-224476">IVF process is a winding journey</a> full of tests, bloodwork and bills. An IVF patient takes hormones for eight to 14 days to stimulate their ovaries to produce many mature eggs. The mature eggs are then retrieved via a minor surgical procedure and fertilized with sperm in a lab. The newly created embryos are monitored, sometimes biopsied and frozen for genetic testing, and then implanted, usually one at a time, in the uterus. From injection to implantation, one round of IVF takes four to eight weeks. </p>
<p>IVF can be as stressful as it is exciting. However, the potential of having a successful pregnancy and our own child at the end of the process, we hoped, would make it all worth it. The decision by the Alabama Supreme Court threw our dreams up in the air.</p>
<p>I <a href="https://scholar.google.com/citations?user=ow6DhIQAAAAJ&hl=en&oi=ao">study politics</a> – I don’t practice it. I’m not involved in state or local government. I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court. As a result, I became something else, too, which I had not been before: an activist.</p>
<h2>Making sense of the ruling</h2>
<p>Throughout the process of creating, growing and testing embryos in a lab, as many as <a href="https://www.illumefertility.com/fertility-blog/ivf-attrition-rate">50% to 70%</a> of embryos <a href="https://theconversation.com/most-human-embryos-naturally-die-after-conception-restrictive-abortion-laws-fail-to-take-this-embryo-loss-into-account-187904">can be lost</a>. Similarly, in the preimplantation stage of natural pregnancies, <a href="https://doi.org/10.12688%2Ff1000research.22655.1">many embryos don’t survive</a>.</p>
<p>If embryos are children, as the court ruled, then fertility clinics and patients would be exposed to an immense amount of potential legal liability. Under this new framework, patients would be able to bring wrongful death suits against doctors for the normal failures of embryos in the testing or implantation phase. Doctors would either have to charge more for an already expensive procedure to cover massive legal-insurance costs or avoid IVF altogether.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A screen shows a microscope's view of a needle and cells." src="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lab staff at an in vitro fertilization lab extract cells from embryos that are then checked for viability.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/FrozenEmbryos/ebbb52ebd68b4ab691798f90b3319f05/photo">AP Photo/Michael Wyke</a></span>
</figcaption>
</figure>
<p>The decision and its implication – that IVF could not continue in the state of Alabama – felt like a personal affront to us. We were infuriated to have this uncertainty injected into the process three days into injecting IVF medication. </p>
<p>While the decision clearly imperiled the future of IVF in Alabama, it was not clear to us whether we would be allowed to continue the process we had begun. We were left completely in the dark for the next four days. Gabby and I had no choice but to continue daily life and IVF as though nothing was happening. </p>
<p>For me, that meant teaching my <a href="https://bulletin.auburn.edu/coursesofinstruction/poli/">political participation course at Auburn University</a>.</p>
<h2>Teaching politics when it gets personal</h2>
<p>I’ll never forget walking into class on Monday, Feb. 19, and telling the students about the court’s ruling and how it – maybe? – was going to jeopardize Gabby’s and my IVF process. </p>
<p>Before starting IVF, Gabby and I had gone through three miscarriages together.</p>
<p>IVF doesn’t always work. Approximately <a href="https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&rdRequestForward=True&ClinicId=9999&ShowNational=1">55% of IVF patients</a> under the age of 35 – Gabby is 26 – have a successful pregnancy after one egg retrieval. We couldn’t imagine the pain of telling friends and family that our attempt at having a child had once again failed. So we had agreed we were going to tell as few people as possible about starting IVF. </p>
<p>Yet, here I was now, telling my entire class what we were going through and how the Alabama Supreme Court ruling could affect us. </p>
<p>I wasn’t alone in sharing our story. The night before my Monday morning class, Gabby published an <a href="https://www.al.com/opinion/2024/02/guest-opinion-alabama-supreme-court-embryo-ruling-may-make-it-difficult-for-us-to-have-children.html">opinion column</a> on our local news site about the ruling and our resulting fears and anxieties, which really resonated with people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clear batches of containers of eggs and embryos in a large, frozen circular container" src="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cryopreservation gives prospective parents more time to pursue pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frozen-embryos-and-eggs-in-nitrogen-cooled-royalty-free-image/520157312">Ted Horowitz Photography/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p>I was, that day and throughout the next few weeks, fixated on the conceptual gulf between the court’s ruling and public opinion. I wondered aloud, “Who’s against IVF? Surely, only 5% to 10% of the public agrees with this ruling.”</p>
<p>The actual numbers aren’t far off my in-class guess. <a href="https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabReport_XLG2Z6p.pdf">Only 8% of Americans</a> say that IVF is immoral or should be illegal. But the story is more nuanced than that. Approximately <a href="https://www.ipsos.com/sites/default/files/ct/news/documents/2024-02/Axios%20Ipsos%20Alabama%20IVF%20Topline%20PDF%202.28.24.pdf">31% of Americans and 49% of Republicans</a> support “considering frozen embryos as people and holding those who destroy them legally responsible.” </p>
<p>In an attempt to tie our personal political experience into the class topic, I remarked that this court decision was a surefire way to get people involved in politics. I had no clue at the time how prophetic my comment would be.</p>
<h2>Fleeing to Texas for reproductive rights?</h2>
<p>On Wednesday, Feb. 21, the <a href="https://www.al.com/news/2024/02/uab-pauses-in-vitro-fertilization-due-to-fear-of-prosecution-officials-say.html">University of Alabama Birmingham’s fertility clinic</a> paused IVF treatments. That wasn’t our clinic, but the move sent us into a total panic. Our clinic’s closure seemed inevitable – and within 24 hours <a href="https://www.nbcnews.com/health/health-news/university-alabama-pauses-ivf-services-court-rules-embryos-are-childre-rcna139846">it had paused IVF treatments as well</a>. </p>
<p>We didn’t know what we were going to do, but we knew we were likely leaving the state to continue IVF. I needed to tell my department chair what was going on.</p>
<p>I was walking out of my department chair’s office when my phone rang. Gabby told me, “We got in, we’re going to Temple.” I ran back into my department chair’s office, told her we were going to Temple, Texas, and then rushed home. </p>
<p><a href="https://www.cnn.com/2024/02/22/us/alabama-embryos-ruling-ivf-treatment-leaving-state/index.html">A reporter from CNN</a> beat me there. It was one of <a href="https://www.washingtonpost.com/nation/2024/02/24/alabama-ivf-treatment-ruling-abortion/">several</a> <a href="https://www.nbcnews.com/health/health-news/ivf-doctors-patients-fearful-alabama-court-rules-embryos-are-children-rcna139636">interviews</a> with <a href="https://apnews.com/video/alabama-assisted-reproductive-technology-courts-legislation-gabby-goidel-8990ee5efaab450b940da1e6a39bf8d1">major</a> <a href="https://www.msnbc.com/katy-tur/watch/-thoughtless-ivf-patients-speak-out-on-alabama-embryo-decision-204655173631">media</a> <a href="https://www.theguardian.com/us-news/2024/feb/22/alabama-fertility-pause-ivf-embryo-ruling">outlets</a> Gabby did in the wake of her opinion column. After the interview, we threw clothes in a suitcase, dropped our dogs off at the vet and drove to the Atlanta airport. We flew to Texas that night.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9MCbgW7i2I0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One of the Goidels’ many media interviews in the wake of the Alabama ruling.</span></figcaption>
</figure>
<p>The thought of not completing the egg retrieval never seriously entered our minds. We were confident that we could get in with another IVF clinic somewhere, anywhere. But we’re affluent. We’re privileged. What if we weren’t so well off? We wouldn’t have wanted to give up, but we wouldn’t have been able to afford the fight.</p>
<p>We spent exactly one week at my parents’ house in Texas. Thankfully, my parents live an hour and a half away from the Temple clinic. We met our new doctor, <a href="https://www.bswhealth.com/physician/gordon-bates">Dr. Gordon Wright Bates</a>, and were immediately reassured. His cool expertise and confidence were calming to a stressed-out couple. The Alabama Supreme Court may have upended our lives, but we felt weirdly lucky to be in such a comfortable place.</p>
<p>The egg retrieval was Wednesday morning, Feb. 28. By all indications, it went well. IVF, however, is full of uncertainties. Now we are waiting on the results from preimplantation genetic testing. After that, there’s implantation and hoping the embryo continues to grow. We’re not in the clear: IVF is a stressful process even without a state court getting in the way. But today we are in a situation more like an average couple going through IVF than we have been in the past few weeks.</p>
<p>Late Wednesday night, March 6, <a href="https://www.nytimes.com/2024/03/06/us/politics/alabama-ivf-law.html">Alabama Gov. Kay Ivey signed into law a bill</a> providing legal protection to IVF clinics in the state. Gabby and I rejoiced at the news. Hopefully, we’re the last Alabamian couple to flee the state for IVF.</p>
<h2>A mobilizing moment</h2>
<p>When state politics directly interferes with your life, it feels like a gut punch, as if the community that you love is saying you’re not loved back. It’s easy to see how such an experience could either discourage or motivate you. Research shows that traumatic events, for the most part, <a href="https://doi.org/10.1017/S0003055422001010">depress voter turnout</a> in the following presidential election. By contrast, families and friends of 9/11 victims <a href="https://doi.org/10.1073/pnas.1315043110">became and remained more politically engaged</a> than their peers. </p>
<p>In this case, the Alabama Supreme Court ruling mobilized Gabby and <a href="https://www.democracynow.org/2024/3/4/alabama_ivf_patients_warning_to_others">other</a> <a href="https://www.today.com/health/news/alabama-ivf-ruling-embryo-transfer-canceled-rcna140029">women</a> going through the IVF process. For better or worse, the women, couples and families mobilized by this decision will likely always be more engaged because of it.</p>
<p>“Oh, God,” I remarked to my dad, “we’re going to be activists now, aren’t we?”</p>
<p>“So?” he asked.</p>
<p>“No one likes activists,” I responded in jest. But if we’re going to have and raise the family we want, this is just the first of many decisions we’re going to make that someone’s not going to like.</p><img src="https://counter.theconversation.com/content/225126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Spencer Goidel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court.Spencer Goidel, Assistant Professor of Political Science, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2245372024-03-07T18:17:30Z2024-03-07T18:17:30ZMedieval women used informal social networks to share health problems and medical advice – just as we do today<figure><img src="https://images.theconversation.com/files/578957/original/file-20240229-28-6ii1vo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C546%2C413&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women spinning and socialising. From Augustine's La Cité de Dieu.</span> <span class="attribution"><a class="source" href="https://philamuseum.org/collection/object/144727">Museum Meermanno</a></span></figcaption></figure><p>In the medieval period, medical science was still dominated by the ancient writings of Hippocrates from the fifth century and Galen of Pergamon from the second century. <a href="https://www.jstor.org/stable/44448504">Research has shown</a> that women were increasingly being taken seriously as healers and as bearers of wisdom about women’s bodies and health. But despite this, men were preferred while women faced restrictions. </p>
<p>Informal networks developed in response, as a way for women to practise medicine in secret – and pass on their medical wisdom outside the male bastions.</p>
<p><a href="https://books.google.co.uk/books/about/The_Distaff_Gospels.html?id=mDX2_0Qb03EC&redir_esc=y">The Distaff Gospels</a>, first published in France around 1480, is a collection of “gospels” around pregnancy, childbirth and health. It was created during secretive meetings of French women who had gathered with their drop spindles and distaffs to spin flax.</p>
<p>These women, who were mostly from the regions of Flanders and Picardy, agreed to meet over the long nights between Christmas and early February to gather the wisdom of their ancestors and pass it on to the women who came after them. The meetings are believed to have been organised by a local villager who selected six older women, each chairing one night, who would recount their advice on a range of topics such as pregnancy, childbirth and marriage. </p>
<p>A scribe was appointed to record the advice, which had previously only been preserved through the oral story tradition of peasant women. What is most fascinating is that although the text is mediated by a male scribe, The Distaff Gospels presents the often-silent voices of the lower working-class women. One such gospel advises:</p>
<p>Young women should never be given hares’ heads to eat, for fear they might think about it later, once they are married, especially while they are pregnant; in that case, for sure, their children would have split lips.</p>
<h2>‘Deviant women’</h2>
<p>The advice is structured in the way it was shared – stories told to each other while spinning. The women discuss folk wisdom related to their domestic lives, and one of the main sections is about pregnancy and reproductive health. </p>
<p>While researching the history of pregnancy tests for my book, <a href="https://canongate.co.uk/books/3664-m-otherhood-on-the-choices-of-being-a-woman/">(M)otherhood</a>, I came across this advice offered in The Distaff Gospels:</p>
<blockquote>
<p>My friends, if you want to know if a woman is pregnant, you must ask her to pee in a basin and then put a latch or a key in it, but it is better to use a latch – leave this latch in the basin with the urine for three or four hours. Then throw the urine away and remove the latch. If you see the impression of the latch on the basin, be sure that the woman is pregnant. If not, she is not pregnant.</p>
</blockquote>
<p><a href="https://broadviewpress.com/product/the-distaff-gospels/#tab-description">Writing about The Distaff Gospels</a>, historians Kathleen Garay and Madeleine Jeay tell us that these texts were written in a mocking fashion, and the scribe describes the women as idiotic, lascivious and even dangerous. </p>
<p>Many of the women healers presiding over these gatherings were thought to be witches or sexually deviant. Nevertheless, through these informal health networks, these women found a way of vesting control and power over themselves, to claim some semblance of autonomy over their own bodies.</p>
<h2>Women supporting women</h2>
<p>Until the 1400s, <a href="https://www.metmuseum.org/toah/hd/medm/hd_medm.htm">medical texts were mediated by men</a>. While women were largely responsible for childbirth advice within informal networks (as women’s naked bodies and anatomy were frequently obscured from men’s eyes), they did not have access to the medical texts that men did. </p>
<p>The Wellcome Apocalypse manuscript, written in Germany around 1420, includes an image of <a href="https://wellcomecollection.org/works/du9ua6nd/items?canvas=80">two women sharing gynaecological problems</a>. One woman is seated and naked, while the other (who seems much older) is dressed in rich clothes. The seated woman has a sign on her stomach that represents her vulva.</p>
<figure class="align-center ">
<img alt="Two medieval women" src="https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578353/original/file-20240227-28-3phk7m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The image from Wellcome Apocalypse, 1420.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/du9ua6nd/items?canvas=80">Wellcome Collection</a></span>
</figcaption>
</figure>
<p>The image is an example of two women discussing intimate worries regarding sexual intercourse, miscarriages, and problems in conceiving. One says: “My husband’s male member, when banging against the smallness and narrowness of my vulva, the cervix, tired out, forced the foetus to slip out before time.” The other responds: “I too have often been distressed because I am unable to carry a conceived child.”</p>
<p>While medieval women did not have the authority or status of trained medical professionals, some, especially in the upper classes, put together recipes for health and wellbeing. One such manuscript is the early 15th-century <a href="https://wellcomecollection.org/works/nuckbt25">Dietary of Queen Isabella</a>, a collection of recipes for maintaining health and combating illness.</p>
<p>Women were also supporting each other’s health through the social network of <a href="https://theconversation.com/letters-and-embroidery-allowed-medieval-women-to-express-their-forbidden-emotions-223114">letter writing</a>. In <a href="https://www.jstor.org/stable/48742766">one such letter from 1455</a>, a woman named Alice Crane writes to her friend Margaret Paston to ask “if the medycyn do you ony good that I send you wrytyng of last”.</p>
<p>As the medical profession became even more institutionalised in the 16th and 17th centuries, women lost much of the respect they’d earned as healers. Many were <a href="https://www.jstor.org/stable/20688683">believed to hold magical powers</a> and <a href="https://imss.org/2019/12/18/a-note-from-the-collections-midwives-and-healers-in-the-european-witch-trials/">castigated as witches</a>. And the informal networks of women sharing medical information, particularly about pregnancy and childbirth, were disrupted.</p>
<p>Today, <a href="https://www.sciencedirect.com/science/article/abs/pii/S027795362100650X">women still often rely</a> on sisters, mothers and friends for reliable information and to make decisions about their sexual and reproductive health. Globally, the reliance on social networks is often <a href="https://www.sciencedirect.com/science/article/abs/pii/S0743016723002358">heightened in rural areas</a>, where illiteracy and lack of access to trained professionals and education can be a barrier. </p>
<p>I see these informal networks, whether operating discreetly in real life or in messaging groups such as Whatsapp, as a form of resistance – a safer, supportive and more egalitarian space than institutionalised medical spaces, where women’s conditions and ailments can be ignored or dismissed. </p>
<hr>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
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<hr><img src="https://counter.theconversation.com/content/224537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pragya Agarwal 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.</span></em></p>The Distaff Gospels is a collection of advice around pregnancy, childbirth and health. It was shared between French women while spinning flax.Pragya Agarwal, Visiting Professor of Social Inequities and Injustice, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2248582024-03-06T03:32:43Z2024-03-06T03:32:43ZSome women’s breasts can’t make enough milk, and the effects can be devastating<figure><img src="https://images.theconversation.com/files/580034/original/file-20240305-22-gta22i.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C1000%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-looking-camera-depression-dark-circles-2364312147">Alberto_Rodriguez/Shutterstock</a></span></figcaption></figure><p>Many new mothers worry about their milk supply. For some, support from a <a href="https://www.breastfeeding.asn.au/breastfeeding-helpline">breastfeeding counsellor</a> or <a href="https://www.lcanz.org/resources/clients/what-is-a-lactation-consultant/">lactation consultant</a> helps.</p>
<p>Others cannot make enough milk no matter how hard they try. These are women whose breasts are not physically capable of producing enough milk. </p>
<p>Our recently published <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">research</a> gives us clues about breast features that might make it difficult for some women to produce enough milk. Another of our studies shows the devastating <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">consequences</a> for women who dream of breastfeeding but find they cannot.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/i-feel-guilty-for-feeling-like-that-one-fifth-of-breastfeeding-women-report-an-aversion-response-208938">'I feel guilty for feeling like that.’ One fifth of breastfeeding women report an aversion response</a>
</strong>
</em>
</p>
<hr>
<h2>Some breasts just don’t develop</h2>
<p>Unlike other organs, breasts are not fully developed at birth. There are key <a href="https://pubmed.ncbi.nlm.nih.gov/33711581/">developmental stages</a> as an embryo, then again during puberty and pregnancy.</p>
<p>At birth, the breast consists of a simple network of ducts. Usually during puberty, the glandular (milk-making) tissue part of the breast begins to develop and the ductal network expands. Then typically, further growth of the ductal network and glandular tissue during pregnancy prepares the breast for lactation.</p>
<p>But our online <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">survey</a> of women who report low milk supply gives us clues to anomalies in how some women’s breasts develop.</p>
<p>We’re not talking about women with small breasts, but women whose glandular tissue (shown in this diagram as “lobules”) is underdeveloped and have a condition called breast hypoplasia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Anatomical diagram of the breast" src="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes not enough glandular tissue, shown here as lobules, develop.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/mammary-gland-vector-illustration-showing-cross-1550556230">Tsuyna/Shutterstock</a></span>
</figcaption>
</figure>
<p>We don’t know <a href="https://doi.org/10.1111/jmwh.12070">how common</a> this is. But it has been <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2021.0032?journalCode=bfm">linked</a> with lower rates of exclusive breastfeeding. </p>
<p>We also don’t know what causes it, with much of the research conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33711581/">in animals</a> and not humans. </p>
<p>However, certain health conditions have been associated with it, including <a href="https://connect.springerpub.com/highwire_display/entity_view/node/154992/full">polycystic ovary syndrome</a> and other endocrine (hormonal) conditions. A high body-mass index around the time of puberty may be another <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">indicator</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-men-have-nipples-120893">Why do men have nipples?</a>
</strong>
</em>
</p>
<hr>
<h2>Could I have breast hypoplasia?</h2>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">survey</a> and other research give clues about who may have breast hypoplasia. </p>
<p>But it’s important to note these characteristics are indicators and do not mean women exhibiting them will definitely be unable to exclusively breastfeed.</p>
<p>Indicators include:</p>
<ul>
<li><p>a <a href="https://pubmed.ncbi.nlm.nih.gov/33586493/">wider than usual gap</a> between the breasts</p></li>
<li><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">tubular-shaped</a> (rather than round) breasts </p></li>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057589/">asymmetric</a> breasts (where the breasts are different sizes or shapes)</p></li>
<li><p>lack of breast growth in pregnancy</p></li>
<li><p>a <a href="https://www.tandfonline.com/doi/full/10.1080/14767058.2023.2214833">delay</a> in or absence of breast fullness in the days after giving birth </p></li>
</ul>
<p>In our survey, 72% of women with low milk supply had breasts that did not change appearance during pregnancy, and about 70% reported at least one <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">irregular-shaped</a> breast.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-expert-tips-on-how-to-look-after-your-baby-in-a-heatwave-216906">5 expert tips on how to look after your baby in a heatwave</a>
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<h2>The effects</h2>
<p>Mothers with low milk supply – whether or not they have breast hyoplasia or some other condition that limits their ability to produce enough milk – report a range of emotions.</p>
<p>Research, <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">including our own</a>, shows this ranges from frustration, confusion and surprise to intense or profound feelings of failure, guilt, grief and despair. </p>
<p>Some mothers describe “<a href="https://bmjopen.bmj.com/content/9/5/e026234">breastfeeding grief</a>” – a prolonged sense of loss or failure, due to being unable to connect with and nourish their baby through breastfeeding in the way they had hoped. </p>
<p>These feelings of failure, guilt, grief and despair can trigger symptoms of <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">anxiety and depression</a> for some women.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired, stress woman with hand over face" src="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=397&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=397&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=397&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Feelings of failure, guilt, grief and despair were common.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-mother-rubbing-face-while-breastfeeding-2371946203">Bricolage/Shutterstock</a></span>
</figcaption>
</figure>
<p>One woman told us:</p>
<blockquote>
<p>[I became] so angry and upset with my body for not being able to produce enough milk.</p>
</blockquote>
<p>Many women’s emotions intensified when they discovered that despite all their hard work, they were still unable to breastfeed their babies as planned. A few women described reaching their “breaking point”, and their experience felt “like death”, “the worst day of [my] life” or “hell”. </p>
<p>One participant told us:</p>
<blockquote>
<p>I finally learned that ‘all women make enough milk’ was a lie. No amount of education or determination would make my breasts work. I felt deceived and let down by all my medical providers. How dare they have no answers for me when I desperately just wanted to feed my child naturally.</p>
</blockquote>
<p>Others told us how they learned to accept their situation. Some women said they were relieved their infant was “finally satisfied” when they began supplementing with formula. One resolved to:</p>
<blockquote>
<p>prioritise time with [my] baby over pumping for such little amounts.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-youre-feeding-with-formula-heres-what-you-can-do-to-promote-your-babys-healthy-growth-106165">If you're feeding with formula, here's what you can do to promote your baby's healthy growth</a>
</strong>
</em>
</p>
<hr>
<h2>Where to go for help</h2>
<p>If you are struggling with low milk supply, it can help to see a <a href="https://www.lcanz.org/resources/clients/how-do-i-access-a-lactation-consultant/">lactation consultant</a> for support and to determine the possible cause. </p>
<p>This will involve helping you try different strategies, such as optimising <a href="https://www.breastfeeding.asn.au/resources/attachment">positioning and attachment</a> during breastfeeding, or <a href="https://www.breastfeeding.asn.au/resources/increasing-supply">breastfeeding/expressing more frequently</a>. You may need to consider taking a medication, such as <a href="https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648">domperidone</a>, to see if your supply increases. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648">Domperidone can boost breast milk supply – here's what you need know</a>
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</em>
</p>
<hr>
<p>If these strategies do not help, there may be an underlying reason why you can’t make enough milk, such as insufficient glandular tissue (a confirmed inability to make a full supply due to breast hypoplasia).</p>
<p>Even if you have breast hypoplasia, you can still breastfeed by giving your baby extra milk (donor milk or formula) via a bottle or using a <a href="https://www.breastfeeding.asn.au/resources/supply-line">supplementer</a> (which involves delivering milk at the breast via a tube linked to a bottle). </p>
<h2>More resources</h2>
<p>The following websites offer further information and support:</p>
<ul>
<li><a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a></li>
<li><a href="https://www.lcanz.org">Lactation Consultants of Australia and New Zealand</a></li>
<li><a href="https://www.thewomens.org.au/health-information/breastfeeding">Royal Women’s Hospital</a>, Melbourne</li>
<li><a href="https://www.facebook.com/groups/SupplyLineBreastfeedersSupportGroupAustralia/">Supply Line Breastfeeders Support Group of Australia</a> Facebook support group</li>
<li><a href="https://www.facebook.com/groups/IGTmamas/">IGT And Low Milk Supply Support Group</a> Facebook support group</li>
<li><a href="https://www.breastfeedingmed.com.au/">Breastfeeding Medicine Network Australia/New Zealand</a></li>
<li><a href="https://professoramybrown.co.uk/articles/f/supporting-breastfeeding-grief---a-collection-of-resources">Supporting breastfeeding grief</a> (a collection of resources).</li>
</ul>
<hr>
<p><em>Shannon Bennetts, a research fellow at La Trobe University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/224858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>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.</span></em></p>Feelings of failure, guilt, grief and despair are common, our study shows. But there is support.Renee Kam, PhD candidate and research officer, La Trobe UniversityLisa Amir, Professor in Breastfeeding Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242572024-02-28T19:11:15Z2024-02-28T19:11:15ZThere is a knowledge gap around menstruation in NZ – and this puts people at risk<p>New Zealand girls and young women, as well as nonbinary persons who bleed every month, have a limited understanding of menstruation. This lack of knowledge about their own bodies is affecting their overall health and wellbeing. </p>
<p>Our ongoing research, currently under peer review, looks at the menstrual health literacy of premenopausal females between 20 and 34 years old (in this article the term “female” is used to refer to individuals with the reproductive organs and hormones that enable menstruation. However, the authors do acknowledge that sex is not binary). We examined how people understood the purpose of hormonal changes and health outcomes (acute and long-term) associated with the menstrual cycle.</p>
<p>The results are concerning in a country where more than half the population is female, and where health education <a href="https://hpe.tki.org.nz/health-and-physical-education-in-the-curriculum/">starts in the first year of school</a>. </p>
<p>But this lack of knowledge is not just a health issue. Anxiety over menstruation, what is normal and what isn’t, spills over to every element of a person’s life, affecting participation in activities such as sport, work, and school. </p>
<p>If New Zealand wants to encourage equal participation in life, then we need to start by properly educating females about how their bodies work. </p>
<h2>A lack of general understanding</h2>
<p>We used a 25-question survey to test menstrual cycle literacy. The questions were divided into four categories: the menstrual cycle, menstruation, symptoms and health outcomes. The final online survey was shared online and completed by 203 females aged 16-40 years. </p>
<p>We found the overall knowledge score for functional menstrual health literacy was low (less than 50%). This means more than half of menstruating individuals may not have an understanding of how hormones within their body can affect them and what symptoms are associated with menstrual cycle changes or disruption. </p>
<p>In particular, we have found a gap in knowledge around the second key hormone governing a person’s menstrual health. While respondents were familiar with <a href="https://www.ncbi.nlm.nih.gov/books/NBK538260/">estrogen</a> and its effects on the body, few were aware of how the second <a href="https://www.ncbi.nlm.nih.gov/books/NBK558960/">key reproductive hormone progesterone</a> affects their bodies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-rags-and-pads-to-the-sanitary-apron-a-brief-history-of-period-products-203451">From rags and pads to the sanitary apron: a brief history of period products</a>
</strong>
</em>
</p>
<hr>
<p>Progesterone is a key hormone for fertility and has roles in maintaining bone health, body fluid regulation and body temperature. It is also the first hormone to change when there is a subtle menstrual cycle disruption.</p>
<p>Failing to understand the importance of this hormone means most females are unaware of how to identify these subtle disruptions. They would most likely miss a lot of the initial warning signals from their body.</p>
<p>Approximately 38% of survey respondents were not aware of what is considered a normal length of the menstrual cycle. This may be associated with increased stress and anxiety commonly experienced with the “unexpected” arrival of their period.</p>
<p>Interestingly, we noted that females tended to score higher on questions where they could use or refer to personal experience (for example, menstrual cycle symptoms and menstruation).</p>
<p>But even here only 50% of females could correctly quantify normal or heavy menstrual blood loss values. Only 10% knew of the changes to cervical mucous that occur with ovulation and are recommended for fertility tracking. </p>
<h2>Missing the danger signs</h2>
<p>The lowest health literacy was reported for the awareness of adverse health outcomes associated with menstrual cycle disruption. </p>
<p>The majority (65%) were unable to correctly identify adverse health and wellbeing outcomes. </p>
<p>High stress, dieting, substantial weight loss and over-training are factors that independently and cumulatively have been found to increase the risk of menstrual cycle disruptions. </p>
<p>These changes in the menstrual cycle will often result in increased gastrointestinal upset, decreased immune response – and in severe cases increase the risk of bone stress injuries. </p>
<p>But the majority (95%) of survey participants only selected “increased risk of bone stress injuries”, the most severe outcome. They were unable to identify any of the other common negative health outcomes that may present first. </p>
<p>It is not uncommon for females to see multiple health or medical professionals when they are concerned with their reproductive health. </p>
<p>The lack of knowledge about what is happening in their body means there can be diagnostic delays or lack of diagnosis. In New Zealand, the average time for a <a href="https://pubmed.ncbi.nlm.nih.gov/35292715/">endometriosis and polycystic ovary syndrome (PCOS) diagnosis</a> is between two and eight years. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lydia-kos-time-of-the-month-comment-showed-how-far-sportswomen-have-come-and-how-much-still-has-to-change-182421">Lydia Ko’s 'time of the month' comment showed how far sportswomen have come – and how much still has to change</a>
</strong>
</em>
</p>
<hr>
<p>Similarly, the majority of females were unable to identify all the factors that could affect the menstrual cycle. Most selected exercise as a key factor responsible for any menstrual cycle disruption. </p>
<p>As a result, most females reported that stopping exercise was what was needed to help menstrual cycle health. </p>
<p>This perception may be a contributing factor to the <a href="https://sportnz.org.nz/itsmymove/overview/?gad_source=1&gclid=Cj0KCQiA5-uuBhDzARIsAAa21T9m5ud_9QUhsW9UO5v8C4yHVhsw1ML_vlUa3a-S-DfKXG_0sLrCEjgaAqa1EALw_wcB">participation in sports gap</a> between young females and males – rising from a 17% gap in sport activity per week at age 16 to a 28% gap at 17. </p>
<h2>Talking about what is (and isn’t) normal</h2>
<p>Our survey results show a pervasive knowledge gap in menstrual cycle health. Most females we surveyed were not aware of what is “normal” for their menstrual cycle, nor did they have a good understanding of the health outcomes associated with menstrual cycle disruptions. </p>
<p>There is a high risk that many females may have a poor quality of life, health and wellbeing due to not being able to access, understand or communicate menstrual health information when it is needed.</p>
<p>This ongoing research is the first step to understanding this pervasive knowledge gap in menstrual cycle health within New Zealand. More research is required to quantify menstrual health literacy in adolescent girls and peri- and post-menopausal women. </p>
<p>Understanding the gaps will give researchers, advocates and educators insight into where we can help improve this basic knowledge – and achieve better outcomes for all those who bleed.</p><img src="https://counter.theconversation.com/content/224257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Badenhorst has received funding from the Health Research Council. </span></em></p><p class="fine-print"><em><span>Stacy T. Sims 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.</span></em></p>Education needs to address the big gaps in the knowledge around the menstrual cycles and the impact menstruation has on a wide range of health outcomes.Claire Badenhorst, Senior Lecturer, Massey UniversityStacy T. Sims, Associate research scientist, Auckland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231942024-02-27T05:35:56Z2024-02-27T05:35:56ZHow to be kind to yourself (without going to a day spa)<figure><img src="https://images.theconversation.com/files/575550/original/file-20240214-26-e51x1x.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-african-woman-looking-outside-window-2003674943">Ground Picture/Shutterstock</a></span></figcaption></figure><p>“I have to be hard on myself,” Sarah told me in a recent telehealth psychology session. “I would never reach my potential if I was kind and let myself off the hook.”</p>
<p>I could empathise with this fear of self-compassion from clients such as Sarah (not her real name). From a young age, we are taught to be kind to others, but self-kindness is never mentioned.</p>
<p>Instead, we are taught success hinges on self-sacrifice. And we need a healthy inner critic to bully us forward into becoming increasingly better versions of ourselves.</p>
<p>But <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167212445599">research shows</a> there doesn’t have to be a trade-off between self-compassion and success. </p>
<p>Self-compassion can help you reach your potential, while supporting you to face the inevitable stumbles and setbacks along the way.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/self-love-might-seem-selfish-but-done-right-its-the-opposite-of-narcissism-205938">'Self-love' might seem selfish. But done right, it's the opposite of narcissism</a>
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</em>
</p>
<hr>
<h2>What is self-compassion?</h2>
<p><a href="https://self-compassion.org/">Self-compassion</a> has <a href="https://www.tandfonline.com/doi/abs/10.1080/15298860309027">three</a> key ingredients.</p>
<p><strong>1. Self-kindness</strong></p>
<p>This involves treating yourself with the same kindness you would extend towards a good friend – via your thoughts, feelings and actions – especially during life’s difficult moments.</p>
<p>For instance, if you find yourself fixating on a minor mistake you made at work, self-kindness might involve taking a ten-minute walk to shift focus, and reminding yourself it is OK to make mistakes sometimes, before moving on with your day.</p>
<p><strong>2. Mindfulness</strong></p>
<p>In this context, mindfulness involves being aware of your own experience of stress or suffering, rather than repressing or avoiding your feelings, or over-identifying with them. </p>
<p>Basically, you must see your stress with a clear (mindful) perspective before you can respond with kindness. If we avoid or are consumed by our suffering, we lose perspective.</p>
<p><strong>3. Common humanity</strong></p>
<p>Common humanity involves recognising our own experience of suffering as something that unites us as being human. </p>
<p>For instance, a sleep-deprived parent waking up (for the fourth time) to feed their newborn might choose to think about all the other parents around the world doing exactly the same thing – as opposed to feeling isolated and alone.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-was-an-expert-advisor-on-the-documentary-how-to-thrive-heres-what-happened-after-this-wellbeing-experiment-191500">I was an expert advisor on the documentary 'How to Thrive'. Here's what happened after this wellbeing experiment</a>
</strong>
</em>
</p>
<hr>
<h2>It’s not about day spas, or booking a manicure</h2>
<p>When Sarah voiced her fear that self-compassion would prevent her success, I explained self-compassion is distinct from self-indulgence.</p>
<p>“So is self-compassion just about booking in more mani/pedis?” Sarah asked. </p>
<p>Not really, I explained. A one-off trip to a day spa is unlikely to transform your mental health.</p>
<p>Instead, self-compassion is a flexible <a href="https://link.springer.com/chapter/10.1007/978-3-031-22348-8_7">psychological resilience factor</a> that shapes our thoughts, feelings and actions. </p>
<p>It’s associated with a suite of benefits to our <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/abs/10.1111/aphw.12051">wellbeing</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/15298868.2011.639548">relationships</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/17437199.2019.1705872">health</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Massage therapist massaging woman's back" src="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575551/original/file-20240214-20-zag2w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A one-off trip to a day spa is unlikely to transform your mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-masseurs-hands-massaging-clients-back-181966475">baranq/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What does the science say?</h2>
<p>Over the past 20 years, we’ve learned self-compassionate people enjoy a wide range of benefits. They tend to be <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/abs/10.1111/aphw.12051">happier</a> and have <a href="https://doi.org/10.1016/j.cpr.2012.06.003">fewer psychological symptoms</a> of distress.</p>
<p>Those high on self-compassion <a href="https://journals.sagepub.com/doi/abs/10.1177/0146167212445599">persevere</a> following a failure. They say they are more motivated to overcome a personal weakness than those low on self-compassion, who are more likely to give up. </p>
<p>So rather than feeling trapped by your inadequacies, self-compassion encourages a <a href="https://hbr.org/2018/09/give-yourself-a-break-the-power-of-self-compassion">growth mindset</a>, helping you reach your potential.</p>
<p>However, self-compassion is not a panacea. It will not change your life circumstances or somehow make life “easy”. It is based on the premise that life is hard, and provides practical tools to cope.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/wellness-is-not-womens-friend-its-a-distraction-from-what-really-ails-us-177446">Wellness is not women's friend. It’s a distraction from what really ails us</a>
</strong>
</em>
</p>
<hr>
<h2>It’s a factor in healthy ageing</h2>
<p>I research menopause and healthy ageing and am especially interested in the value of self-compassion through menopause and in the second half of life. </p>
<p>Because self-compassion becomes important during life’s challenges, it can help people navigate physical symptoms (for instance, <a href="https://www.sciencedirect.com/science/article/pii/S0378512214001649?via%3Dihub">menopausal hot flushes</a>), life transitions such as <a href="https://journals.sagepub.com/doi/10.1177/0956797611429466">divorce</a>, and <a href="https://link.springer.com/chapter/10.1007/978-3-031-22348-8_7">promote healthy ageing</a>.</p>
<p>I’ve also teamed up with researchers at <a href="https://www.autismspectrum.org.au/">Autism Spectrum Australia</a> to explore self-compassion in autistic adults. </p>
<p>We found autistic adults report significantly <a href="https://link.springer.com/article/10.1007/s10803-022-05668-y">lower levels</a> of self-compassion than neurotypical adults. So we developed an online <a href="https://www.autismspectrum.org.au/blog/new-online-self-compassion-program-for-autistic-adults">self-compassion training program</a> for this at-risk population.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-is-teaching-the-world-about-autism-but-is-it-empowering-autistic-people-or-pigeonholing-them-192093">TikTok is teaching the world about autism – but is it empowering autistic people or pigeonholing them?</a>
</strong>
</em>
</p>
<hr>
<h2>Three tips for self-compassion</h2>
<p>You <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.21923">can learn</a> self-compassion with these three exercises.</p>
<p><strong>1. What would you say to a friend?</strong></p>
<p>Think back to the last time you made a mistake. What did you say to yourself?</p>
<p>If you notice you’re treating yourself more like an enemy than a friend, don’t beat yourself up about it. Instead, try to think about what you might tell a friend, and direct that same friendly language towards yourself.</p>
<p><strong>2. Harness the power of touch</strong></p>
<p>Soothing human touch <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.555058/full">activates</a> the parasympathetic “relaxation” branch of our nervous system and counteracts the fight or flight response. </p>
<p>Specifically, self-soothing touch (for instance, by placing both hands on your heart, stroking your forearm or giving yourself a hug) <a href="https://www.sciencedirect.com/science/article/pii/S2666497621000655">reduces</a> cortisol responses to psychosocial stress.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Middle-aged man hugging himself" src="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575557/original/file-20240214-28-qoatq3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Yes, hugging yourself can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-age-hoary-man-wearing-brown-1667780113">Krakenimages.com/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>3. What do I need right now?</strong></p>
<p>Sometimes, it can be hard to figure out exactly what self-compassion looks like in a given moment. The question “what do I need right now” helps clarify your true needs.</p>
<p>For example, when I was 37 weeks pregnant, I woke up bolt awake one morning at 3am.</p>
<p>Rather than beating myself up about it, or fretting about not getting enough sleep, I gently placed my hands on my heart and took a few deep breaths. By asking myself “what do I need right now?” it became clear that listening to a gentle podcast/meditation fitted the bill (even though I wanted to addictively scroll my phone).</p><img src="https://counter.theconversation.com/content/223194/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lydia Brown occasionally works as a clinical psychologist in private practice.</span></em></p>A one-off trip to a day spa is unlikely to transform your mental health. But these expert tips might help you cut yourself some slack.Lydia Brown, Senior Lecturer in Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2242372024-02-26T01:47:21Z2024-02-26T01:47:21ZWhat is Ryeqo, the recently approved medicine for endometriosis?<figure><img src="https://images.theconversation.com/files/577738/original/file-20240225-24-jk5b3s.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938369/">Pexels/Sora Shimazaki</a></span></figcaption></figure><p>For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that <a href="https://www.instagram.com/p/CP2i5xKl9tS/">impacts their daily life</a>. It is a condition that is both difficult to diagnose and treat, with many women needing either <a href="https://www.thewomens.org.au/health-information/periods/endometriosis/">surgery or regular medication</a>.</p>
<p>A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.</p>
<p>Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-with-endometriosis-and-pcos-wait-years-for-a-diagnosis-attitudes-to-womens-pain-may-be-to-blame-179500">People with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame</a>
</strong>
</em>
</p>
<hr>
<h2>What does Ryeqo do?</h2>
<p>Endometriosis <a href="https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/how-common-is-endometriosis">affects 14% of women of reproductive age</a>. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.</p>
<p>Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone. </p>
<p>Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the <a href="https://www.mayoclinic.org/drugs-supplements/relugolix-oral-route/description/drg-20506394">treatment of prostate cancer</a>. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in <a href="https://www.menopause.org.au/health-info/fact-sheets/what-is-menopausal-hormone-therapy-mht-and-is-it-safe">menopausal hormone therapy</a>. Norethisterone is a synthetic hormone commonly used in birth control medications and to <a href="https://www.netdoctor.co.uk/medicines/a8713/norethisterone/">delay menstruation and help with heavy menstrual bleeding</a>.</p>
<p>All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms. </p>
<p>Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-government-inquiry-will-examine-womens-pain-and-treatment-how-and-why-is-it-different-221747">A new government inquiry will examine women's pain and treatment. How and why is it different?</a>
</strong>
</em>
</p>
<hr>
<h2>Is it really new?</h2>
<p>The maker of Ryeqo claims it is the <a href="https://www.gedeonrichter.com/au/-/media/sites/au/documents/media-release-c_ryeqo-tga-approval_gedeon-richter-australia_final.pdf?rev=1cc37d3726f84e9ca71d4c094c1e3dd6">first new drug for endometriosis in Australia in 13 years</a>.</p>
<p>But individually, all three active ingredients in Ryeqo have been in use since <a href="https://link.springer.com/article/10.1007/s40265-019-01105-0#:%7E:text=Relugolix%20received%20its%20first%20global,with%20uterine%20fibroids%20in%20Japan.">2019</a> or earlier. </p>
<p>Ryeqo has been available in Australia <a href="https://www.tga.gov.au/resources/artg/375414">since 2022</a>, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of <a href="https://www.ema.europa.eu/en/medicines/human/EPAR/ryeqo">uterine fibroids</a>, which share some <a href="https://www.medicalnewstoday.com/articles/fibroid-vs-endometriosis#similarities">common symptoms</a> with endometriosis and have related causes.</p>
<p>In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved. </p>
<p>The oral medicine <a href="https://www.tga.gov.au/resources/artg/336684">Dienogest</a> was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as <a href="https://www.tga.gov.au/resources/artg/401897">Sayana Press</a> which was approved in a smaller dose form for self-injection in 2023. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hands taking pill out of contraceptive blister pack" src="https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577780/original/file-20240225-28-5t517.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can’t take the contraceptive pill with Ryeqo but the endometriosis drug could replace it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/contraceptive-pill-174193232">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How to take it and what not to do</h2>
<p>Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.</p>
<p>It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.</p>
<p>Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-CMI-01327-1&d=20240224172310101">it will take at least one month of use to be effective</a>. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.</p>
<p>Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.</p>
<p>The possible <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2022-PI-01955-1">side effects of Ryeqo</a> are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-a-tens-machine-can-it-help-my-period-pain-or-endometriosis-201389">What's a TENS machine? Can it help my period pain or endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>It’s costly for now</h2>
<p>Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis. </p>
<p>While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the <a href="https://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee">normal PBS price of up to A$31.60</a>, it has been reported it may <a href="https://www.9news.com.au/national/it-never-stops-new-drug-approved-to-treat-endometriosis-after-decade-of-pain/b51f0e92-6dd8-4812-800a-eadac0d55218">cost as much as $135</a> for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.</p>
<hr>
<p><em>Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.</em></p><img src="https://counter.theconversation.com/content/224237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Jasmine Lee 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.</span></em></p>A drug newly approved by the Therapeutic Goods Administration for endometriosis is available in Australia.Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJasmine Lee, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230082024-02-21T03:45:57Z2024-02-21T03:45:57ZWhy do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?<figure><img src="https://images.theconversation.com/files/576612/original/file-20240219-26-qkb5eg.jpg?ixlib=rb-1.1.0&rect=209%2C473%2C7139%2C4429&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-tired-young-tattooed-business-woman-1703410366">BAZA Productions/Shutterstock</a></span></figcaption></figure><p>Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial.</p>
<p>UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. </p>
<p>Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year.</p>
<p>They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area.</p>
<p>Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments.</p>
<h2>Why are chronic UTIs so hard to treat?</h2>
<p>Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. </p>
<p>The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. </p>
<p>This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
</strong>
</em>
</p>
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<figure class="align-center ">
<img alt="Underpants hanging on a clothesline" src="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576616/original/file-20240219-28-iawpj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some antibiotics no longer work against UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womens-underwear-hangs-on-clothesline-687500683">Michael Ebardt/Shutterstock</a></span>
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</figure>
<p>Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. </p>
<p>But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead.</p>
<p>Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. </p>
<p>Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. </p>
<p>The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. </p>
<p>For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur.</p>
<p>Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. </p>
<p>Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cranberry-juice-can-prevent-recurrent-utis-but-only-for-some-people-203926">Cranberry juice can prevent recurrent UTIs, but only for some people</a>
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</em>
</p>
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<h2>What treatments might we see in the future?</h2>
<p>Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. </p>
<figure class="align-center ">
<img alt="Gynaecologist talks to patient" src="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576617/original/file-20240219-16-qgkamv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Emerging treatments could help clear chronic UTIs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gynecologist-talks-patient-during-medical-consultation-2298674535">guys_who_shoot/Shutterstock</a></span>
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</figure>
<p>Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. </p>
<p>Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. </p>
<p>Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response.</p>
<p>Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.</p>
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<strong>
Read more:
<a href="https://theconversation.com/phage-therapy-could-treat-some-drug-resistant-superbug-infections-but-comes-with-unique-challenges-207025">'Phage therapy' could treat some drug-resistant superbug infections, but comes with unique challenges</a>
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<img src="https://counter.theconversation.com/content/223008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Iris Lim 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.</span></em></p>Chronic UTIs come back repeatedly or never fully go away despite treatment.Iris Lim, Assistant Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202822024-02-15T00:00:55Z2024-02-15T00:00:55ZFeminist narratives are being hijacked to market medical tests not backed by evidence<figure><img src="https://images.theconversation.com/files/575240/original/file-20240213-27-twey75.jpg?ixlib=rb-1.1.0&rect=252%2C97%2C6218%2C4210&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-floor-and-leaning-on-couch-using-laptop-Nv-vx3kUR2A">Thought Catalog/Unsplash</a></span></figcaption></figure><p>Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, <a href="https://www.mdpi.com/1660-4601/17/21/7902">such as tobacco and alcohol</a>. </p>
<p>Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups. </p>
<p>Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women. </p>
<p>However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment. </p>
<p>In our analysis published today in the <a href="https://www.bmj.com/content/384/bmj-2023-076710">BMJ</a>, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.</p>
<h2>The AMH test</h2>
<p>The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test. </p>
<p>Although often used in fertility treatment, the AMH test cannot reliably predict the <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">likelihood of pregnancy</a>, timing to pregnancy or <a href="https://academic.oup.com/humupd/article/29/3/327/6990969">specific age of menopause</a>. The American College of Obstetricians and Gynaecologists therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30913192/">strongly discourages testing</a> for women not seeking fertility treatment. </p>
<figure class="align-center ">
<img alt="Woman sits in a medical waiting room" src="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575242/original/file-20240213-24-tbgpbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The AMH test can’t predict your chance of getting pregnant.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-a-bench-in-a-waiting-area-UssKpGyrBzw">Anastasia Vityukova/Unsplash</a></span>
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<p>Despite this, several <a href="https://bmjopen.bmj.com/content/11/7/e046927.info">fertility clinics</a> and <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808552">online companies</a> market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “<a href="https://www.ondemand.labcorp.com/lab-tests/womens-fertility-test">you deserve</a> to know your reproductive potential”, “<a href="https://kinfertility.com.au/fertility-test">be proactive</a> about your fertility” and “<a href="https://monashivf.com/services/early-intervention/amh-blood-test/">knowing your numbers</a> will empower you to make the best decisions when family planning”. </p>
<p>The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-hype-egg-timer-tests-cant-reliably-predict-your-chance-of-conceiving-or-menopause-timing-207008">Don't believe the hype. 'Egg timer' tests can't reliably predict your chance of conceiving or menopause timing</a>
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<p>Our <a href="https://academic.oup.com/humrep/article/38/8/1571/7193900?login=false">recent study</a> found around 30% of women having an AMH test in Australia may be having it for these reasons.</p>
<p>Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.</p>
<p>While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment. </p>
<h2>Breast density notification</h2>
<p>Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue. </p>
<p>While estimates vary, approximately 25–50% of women in the breast screening population <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200066/">have dense breasts</a>.</p>
<figure class="align-center ">
<img alt="Young woman has mammogram" src="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575244/original/file-20240213-22-kbvlxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dense breasts can make it harder to detect cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-taking-mammogram-xray-test-75178006">Tyler Olsen/Shutterstock</a></span>
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<p>Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know <a href="https://insightplus.mja.com.au/2022/34/breast-density-we-can-handle-the-truth/#:%7E:text=%E2%80%9CWomen%20can%20handle%20the%20truth,need%20to%20know%20that%20truth.">such as</a> “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification. </p>
<p>However, this simplistic messaging overlooks that this is a complex issue and that <a href="https://ebm.bmj.com/content/26/6/309">more data is still needed</a> on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-breast-cancer-in-women-what-we-know-dont-know-and-suspect-86314">What causes breast cancer in women? What we know, don't know and suspect</a>
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<p>Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1912943">lack of robust evidence</a> showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results. </p>
<p>Large international advocacy groups are also sponsored by companies that will <a href="https://www.volparahealth.com/news/volpara-announces-expanded-sponsorship-of-densebreast-info-org-at-sbi-2023/">financially benefit from women being notified</a>.</p>
<p>While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought. </p>
<h2>Ensuring feminism isn’t hijacked</h2>
<p>Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care. </p>
<p>But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests. </p>
<p>Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-women-wont-be-told-how-to-behave-but-is-girlboss-just-deportment-by-another-name-132351">Young women won't be told how to behave, but is #girlboss just deportment by another name?</a>
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<img src="https://counter.theconversation.com/content/220282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Nickel receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is on the Scientific Committee of the Preventing Overdiagnosis Conference.</span></em></p><p class="fine-print"><em><span>Tessa Copp receives fellowship funding from the National Health and Medical Research Council (NHMRC). She is also on the Scientific Committee of the Preventing Overdiagnosis Conference. </span></em></p>Corporate medicine is hijacking feminist narratives around empowerment and women’s rights to market technologies, tests and treatments that aren’t backed by evidence.Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of SydneyTessa Copp, NHMRC Emerging Leader Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225162024-02-11T13:50:24Z2024-02-11T13:50:24ZIt’s time for a heart-to-heart about women’s cardiovascular health, unique risk factors and symptoms<p>Cardiovascular disease — also called heart disease — is a condition affecting the heart and blood vessels, and is the leading cause of death among <a href="https://doi.org/10.1016/S0140-6736(21)00684-X">women worldwide</a>. In fact, a women dies of heart disease every <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">20 minutes in Canada</a>. </p>
<p>Although cardiovascular disease is often considered a disease of men, women are more likely to die from a <a href="https://doi.org/10.1016/j.cjco.2020.10.009">heart attack</a> when compared with men. This fact often surprises women and even their health-care providers. Many women are not aware that heart disease is a significant health threat to them, but the reality is that <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">five times</a> as many women die from heart disease as breast cancer. </p>
<p>Despite dramatic improvements in management of cardiovascular disease over time, the death rate due to heart disease is <a href="https://doi.org/10.1093/ehjqcco/qcaa099">actually increasing</a> in women, especially those under age 65. It has become clear that <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#">women remain</a> under-researched, under-diagnosed, under-treated, under-supported an under-aware of their cardiovascular risk. </p>
<p>That’s why it is critical that moving forward, we recognize that women’s hearts are unique. Additionally, there is an urgent need to start a conversation with Canadians to improve awareness of women’s heart health to help save the lives of mothers, sisters, daughters, family and friends. </p>
<h2>Women’s hearts are different</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of women wearing red and with the title Wear Red Canada wearredcanada.ca" src="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574087/original/file-20240207-26-jtv39j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">On Feb. 13, Wear Red Canada raises awareness for women’s cardiovascular health.</span>
<span class="attribution"><span class="source">(Canadian Women's Heart Health Centre)</span></span>
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</figure>
<p>From the outside, women’s hearts may look the same as men’s, but there are important differences. Specifically, women experience unique events over the course of their lifespan which may impact their cardiovascular health. For example, an individual’s <a href="https://doi.org/10.1016/j.cjco.2021.09.013">menstrual health and patterns, or conditions related to fertility</a>, such as polycystic ovary syndrome or endometriosis, may influence her cardiovascular well-being. </p>
<p>Pregnancy complications, such as hypertensive disorders of pregnancy and gestational diabetes, can also play a role in cardiovascular health. Finally, menopause factors, including timing of menopause and menopause-related treatments, may also be indicators of cardiovascular health. </p>
<p>In addition to such risk factors that are inherent to the female experience, women are <a href="https://www.cjcopen.ca/cms/attachment/a2d5edd9-5a5a-41d4-b824-7749ae0d9a67/gr1.jpg">disproportionately impacted by other risk factors for heart disease</a>. These risk factors may include conditions such as depression, chronic kidney disease and autoimmune disease. </p>
<p>Women need to not only be aware of how their risk for heart disease may change across the lifespan, but also how they can be proactive and make informed decisions regarding their heart health at all stages of life. </p>
<h2>Heart attack symptoms</h2>
<p>Early heart attack symptoms are missed in up to <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2018-heart-month/hs_2018-heart-report_en.ashx#:%7E:text=Every%2020%20minutes%20a%20woman%20in%20Canada%20dies%20from%20heart%20disease.&text=Five%20times%20as%20many%20women%20die%20from%20heart%20disease%20as%20breast%20cancer.&text=Two%2Dthirds%20of%20heart%20disease%20clinical%20research%20focuses%20on%20men.&text=Women%20who%20have%20a%20heart,heart%20attack%20compared%20to%20men.">78 per cent</a> of women, in part related to the fact that women may present with different symptoms than men. </p>
<p>Similar to men, women often present with chest pain or discomfort, though they may have additional or <a href="https://doi.org/10.1161/CIRCULATIONAHA.117.031650">alternative symptoms</a> such as jaw, neck or back pain, shortness of breath, nausea, indigestion and extreme fatigue. In fact, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. </p>
<p>An awareness of the differences in heart attack symptoms may lead to improved recognition and timely care for women. </p>
<p>Recognizing that women can have different cardiovascular risk factors, symptoms and even types of heart disease can be scary and overwhelming. However, there is good news! It is estimated that approximately <a href="https://world-heart-federation.org/what-we-do/prevention/#:%7E:text=An%20estimated%2080%25%20of%20cardiovascular,and%20">80 per cent</a> of cardiovascular disease is preventable.</p>
<h2>Reducing heart risks</h2>
<figure class="align-center ">
<img alt="Group of women outdoors in athletic clothes carrying yoga mats" src="https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574724/original/file-20240209-18-8p1xc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s estimated that about 80 per cent of heart disease is preventable.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>There are many steps that you can take to reduce your risk of heart disease. <a href="https://www.heartandstroke.ca/heart-disease/risk-and-prevention/lifestyle-risk-factors">Staying active</a> and moving every day, and even small steps to reduce sedentary time can be beneficial. </p>
<p>Eating a healthy and <a href="https://www.heartandstroke.ca/healthy-living/healthy-eating">balanced diet</a> is also important. Aim to eat a variety of healthy foods and try to limit highly processed foods and salt. How you eat also matters: listen to your body by eating when you are hungry, but stopping once you are satisfied. </p>
<p>Living free from commercial tobacco and vaping, reducing alcohol intake and managing stress are also key ways to reduce your risk. Finally, take your medications as prescribed and have regular check-ups with your health-care providers.</p>
<h2>Wear red and learn more</h2>
<p>On Feb. 13, we invite you to celebrate <a href="https://wearredcanada.ca">Wear Red Canada</a> to raise awareness for women’s cardiovascular health, hosted by the <a href="http://cwhhc.ottawaheart.ca/national-alliance/cwhha">Canadian Women’s Heart Health Alliance</a> and the <a href="https://cwhhc.ottawaheart.ca/">Canadian Women’s Heart Health Centre</a>. Wear red and share selfies or pictures of your participation by using the hashtag #HerHeartMatters and tagging @WearRedCanada to help spread this important message. </p>
<p>Attend free <a href="https://wearredcanada.ca/educational-webinars">presentations and webinars</a> by Canadian experts, join the <a href="https://raceroster.com/events/2024/77122/wear-red-canada-movement-challenge?utm_source=Cyberimpact&utm_medium=email&utm_campaign=Countdown-1-Week-Until-the-Wear-Red-Canada-Movement-Challenge-Begins--Register-Today">Wear Red Canada Movement Challenge</a> and take part in local events. </p>
<p>By wearing red on Feb. 13 and starting conversations about women’s heart health, we all can increase awareness and improve the heart health of the women we love.</p><img src="https://counter.theconversation.com/content/222516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nabilah Gulamhusein has received funding from the Canadian Institutes of Health Research through the Canada Graduate Scholarship - Master’s.</span></em></p><p class="fine-print"><em><span>Sandi Dumanski receives funding from the Canadian Fertility and Andrology Society and the Kidney Foundation.</span></em></p>It’s important for women to not only be aware of their risk for heart disease, but also how they can be proactive and make informed decisions regarding their heart health at all stages of life.Nabilah Gulamhusein, PhD Student, Medical Sciences, University of CalgarySandi Dumanski, Assistant Professor, Department of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215382024-01-25T16:32:05Z2024-01-25T16:32:05ZWomen are more likely to develop Alzheimer’s – but our research suggests a specific brain enzyme could help protect them<figure><img src="https://images.theconversation.com/files/571499/original/file-20240125-31-5bjzgi.jpg?ixlib=rb-1.1.0&rect=763%2C424%2C4248%2C2588&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womens-mental-health-concept-nervous-system-2198177721">Shutterstock/Pavlova Yuliia</a></span></figcaption></figure><p>The <a href="https://www.cdc.gov/aging/aginginfo/alzheimers.htm#:%7E:text=Alzheimer's%20disease%20is%20the%20most,and%20respond%20to%20the%20environment">most common form of dementia</a>, Alzheimer’s, is a progressive, life limiting, neurodegenerative condition, which damages and destroys parts of the nervous system, especially the brain, over time. </p>
<p>Women are most likely to be affected. They make up <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s">two-thirds of people</a> with Alzheimer’s. It is not yet understood why <a href="https://www.alzheimers.org.uk/blog/why-dementia-different-women">women have greater risk</a> of developing the disease – but there does seem to be a link with the menopause.</p>
<p><a href="https://www.science.org/doi/10.1126/sciadv.adj1354">Our latest research</a> has examined this link <a href="https://www.science.org/doi/10.1126/sciadv.adj1354">and it suggests</a> that the activation of a brain protein called CYP46A1, using an anti-HIV drug, could help protect women from developing disease.</p>
<p><a href="https://www.medicalnewstoday.com/articles/155651#_noHeaderPrefixedContent">Women transition into menopause</a>, usually between 45 and 55 years of age. Menopause is caused by <a href="https://www.medicalnewstoday.com/articles/321064#symptoms">loss of oestrogen</a>, a hormone essential for maintaining brain health as well as learning and memory skills. </p>
<p>Early menopause, with onset before 45 years, is a risk factor for memory loss and for developing Alzheimer’s disease later in life. </p>
<p>Research suggests that women who experience <a href="https://www.medicalnewstoday.com/articles/alzheimers-early-age-at-menopause-late-start-to-hormone-therapy-may-be-a-risk-factor#:%7E:text=%E2%80%9CWe%20found%20that%20in%20multiple,years%20in%20the%20United%20States">early menopause</a> who go on to get Alzheimer’s disease have higher levels of a protein called <a href="https://www.alz.org/media/Documents/alzheimers-dementia-tau-ts.pdf">tau</a> in their brain, which is a hallmark of the disease. Tau is a protein that stabilises neurons – the nerve cells that send messages all over your body to allow you to do everything from breathing to talking, eating, walking, and thinking. In people with Alzheimer’s, tau forms toxic tangles, which contribute to the deterioration of brain functions and memory loss.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/81fEob0r8Xk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Women and dementia, Alzheimer’s Research UK, 2015.</span></figcaption>
</figure>
<h2>Activating brain protein CYP46A1</h2>
<p><a href="https://www.science.org/doi/10.1126/sciadv.adj1354">Our study</a> shows that activation of a brain protein called CYP46A1 could protect women from developing Alzheimer’s disease. </p>
<p>The main function of this protein in the brain is to get rid of excess cholesterol by transforming it into a cholesterol product called 24S-hydroxycholesterol (24SOH). When CYP46A1 levels are increased in the brains of mice, also heightening the production of 24SOH, females present healthier neurons and higher oestrogen activity in the hippocampus – the brain region essential for memory. </p>
<p>The female mice with high CYP46A1 levels showed enhanced memory capacities. Just like humans, when mice get old their memory worsens compared to young mice, and the same is true for menopausal mice compared to non-menopausal mice. Activation of CYP46A1 counteracted memory loss both during aging and during menopause – but only in the female mice. </p>
<p>In male mice, activation of CYP46A1 led instead to worsening memory and accumulation of the male hormone <a href="https://my.clevelandclinic.org/health/articles/24555-dht-dihydrotestosterone">di-hydro-testosterone</a> in their brains.</p>
<p>To understand better how the CYP46A1 protein could have different effects in male and female mice, we grew neurons in culture (on plastic plates in the lab) and treated them with the CYP46A1 product, 24SOH. </p>
<p>In these neurons, 24SOH increased hormone activity, especially oestrogen. We found that increasing oestrogen activity develops healthier and better functioning neurons, explaining the protective effects of the hormone in female mice. However, the male mice did not benefit in the same way because high levels of dihydrotestosterone blocked the positive effects of oestrogen. </p>
<p>Results from mice were supported with studies in people with Alzheimer’s disease. In the <a href="https://www.science.org/doi/10.1126/sciadv.adj1354">human study</a>, 24SOH was measured in the cerebrospinal fluid (the liquid around the brain and spinal cord) of patients from Karolinska Hospital, Sweden. Higher 24SOH levels corresponded to lower levels of <a href="https://www.sciencedirect.com/science/article/pii/S2666144621000125#:%7E:text=Dynamic%20Biomarkers%20of%20AD%20Pathology,are%20drawn%20concordantly%20(orange).">Alzheimer’s pathological markers</a> like tau – but only in women. </p>
<p>This suggests that the possible protective effect of high levels of CYP46A1 and 24SOH on Alzheimer’s disease is exclusively for women.</p>
<h2>Anti-HIV drug helpful for Alzheimer’s</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797897/">Previous research</a> has shown that CYP46A1 can be activated by low doses of the commercial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9855767/">anti-HIV drug Efavirenz</a>. Efavirenz has been <a href="https://www.alzdiscovery.org/uploads/cognitive_vitality_media/Efavirenz-Cognitive-Vitality-For-Researchers.pdf">proposed as Alzheimer’s therapy</a> because lab studies showed beneficial effects against tau and amyloid plaques (where proteins clump together and disrupt cell function), which is known to accumulate in the brains of people with Alzheimer’s. </p>
<p>But the results from our study suggest different effects of CYP46A1 activation in men and women – with beneficial effects prominently in women.</p>
<figure class="align-center ">
<img alt="Gloved hand taking a pack of medication labelled Efaviernz 200mg from a box containing many packs of the drug" src="https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">HIV drug Efavirenz may help to protect women from developing Alzheimer’s disease.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/the-first-batch-of-aids-drug-efavirenz-produced-in-india-news-photo/157448055?adppopup=true">EVARISTO SA/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>CYP46A1 activators like Efavirenz may offer a new therapeutic approach to promote oestrogen-mediated brain protection in women at risk of Alzheimer’s disease – women with early menopause, for example. </p>
<p>This approach is different from hormone replacement therapies (HRT), which have <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-022-01121-5">yielded variable results so far</a>. The use of HRT seems to reduce the risk of women developing Alzheimer’s disease – but only if given at the time of menopause symptoms. There seems to be no protective effect if given after menopause – and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/">HRT is controversial</a> after being <a href="https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy">linked to a higher risk of cancer</a>. </p>
<p>New possibilities of increasing oestrogen activity in the brains of women, then, are welcome – and have the potential to become preventative therapy against devastating neurodegenerative diseases like Alzheimer’s.</p><img src="https://counter.theconversation.com/content/221538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Silvia Maioli receives funding from Margaretha af Ugglas Foundation, The private initiative "Innovative ways to fight Alzheimer´s disease - Leif Lundblad Family and others, NIH R01 grant, King Gustaf V:s and Queen Victorias Foundation, Gun & Bertil Stohnes Foundation, Foundation for Old Servants and Karolinska Institute KID funding.</span></em></p>Two thirds of people with Alzheimer’s disease are women – but activation of a brain protein called CYP46A1 might hold the key to prevention.Silvia Maioli, Senior Research Specialist and Associate professor, Neurobiology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173682024-01-24T23:40:59Z2024-01-24T23:40:59ZExtreme heat can be risky during pregnancy. How to look after yourself and your baby<figure><img src="https://images.theconversation.com/files/570779/original/file-20240123-25-6rr05.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6709%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kid-kissing-belly-her-mom-633713483">Shutterstock</a></span></figcaption></figure><p>As we face the continued effects of <a href="https://www.lancetcountdown.org/2023-report/">climate change</a>, the frequency and intensity of heatwaves is increasing. We’ve recently learnt 2023 was <a href="https://www.climatecouncil.org.au/resources/2023-named-hottest-year-record-scorching-temps-sweep-australia/">the hottest year</a> on record.</p>
<p>Extreme heat presents a major public health threat. It can be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01208-3/fulltext">especially dangerous</a> for people who are socioeconomically disadvantaged, and people who have reduced physiological ability to adapt, such as older adults and those with certain medical conditions.</p>
<p>Pregnant people are also more vulnerable, with evidence showing exposure to extreme heat <a href="https://pubmed.ncbi.nlm.nih.gov/37501633/">is associated with</a> increased risks for the baby.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-can-stress-during-pregnancy-harm-my-baby-81825">Health Check: can stress during pregnancy harm my baby?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the risks?</h2>
<p>Globally one stillbirth occurs <a href="https://www.unicef.org/reports/neglected-tragedy-global-burden-of-stillbirths-2020">every 16 seconds</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/30389451/">15 million babies</a> are born preterm (before 37 complete weeks of pregnancy) every year. Complications of preterm birth are the leading cause of death and disability for children aged under five years old. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33148618/">systematic review</a> which included studies from 27 countries showed that for every 1˚C increase in ambient (environmental) temperature, the risk for preterm birth and stillbirth increased by 5%.</p>
<p>The risk of stillbirth and preterm birth attributed to heat is greater in lower- and middle-income countries where women are often employed in agriculture or other manual labour positions, and their work continues until <a href="https://pubmed.ncbi.nlm.nih.gov/35237548/">the end of their pregnancy</a>. </p>
<p>Within high-income countries the risk <a href="https://pubmed.ncbi.nlm.nih.gov/34951022/">is greater</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/35710419/">disadvantaged populations</a>.</p>
<p>Recent Australian research has also suggested a mother’s exposure to extreme temperatures may <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP12660">influence a baby’s birth weight</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman drinks glass of water" src="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Make sure you stay hydrated while pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-water-drinking-woman-young-pregnancy-2177419759">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-expert-tips-on-how-to-look-after-your-baby-in-a-heatwave-216906">5 expert tips on how to look after your baby in a heatwave</a>
</strong>
</em>
</p>
<hr>
<p>Pregnant people are thought to be at increased risk of heat stress due to changes in their body’s capacity to <a href="https://pubmed.ncbi.nlm.nih.gov/37501633/">regulate temperature</a>. These changes include:</p>
<ul>
<li><p>increased body mass and body fat which reduces a pregnant woman’s ability to dissipate heat to the environment </p></li>
<li><p>decreased ratio of surface area to body mass can make sweating less effective</p></li>
<li><p>additional energy produced from the baby increases the mother’s core body temperature. </p></li>
</ul>
<h2>The effects on the body and baby</h2>
<p>When the ambient environment is hotter than the pregnant woman’s core body temperature (that is when the air temperature reaches around 38 degrees or above) blood flow is diverted to the skin to allow sweating. This can decrease blood flow to the placenta, meaning less nutrition and oxygen to the baby.</p>
<p>If dehydration occurs, hormonal changes can include the release of prostaglandin and oxytocin, potentially triggering labour prematurely. </p>
<p>Heat exposure can also release heat-shock protein (a family of proteins produced by cells secondary to stressful conditions) which can damage placental cells and placental function. This can contribute to poor fetal nutrition, leading to <a href="https://pubmed.ncbi.nlm.nih.gov/30594173/">low birth weight</a>. </p>
<p>However, actual thermo-physiological data from pregnant women during heat exposure is sparse. Our <a href="https://pubmed.ncbi.nlm.nih.gov/29496695/">recent review</a> showed no study has assessed thermoregulatory function in pregnant women at temperatures higher than 25˚C. </p>
<p>Our subsequent <a href="https://pubmed.ncbi.nlm.nih.gov/34165763/">climate chamber study</a> with pregnant women showed their bodies regulate temperature up to 32˚C as well as non-pregnant women.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in sun hat sits with legs in swimming pool. She appears pregnant." src="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dipping your feet into a cool pool can help you and your baby cool off.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-young-pregnant-woman-sitting-near-422267806">Tanya Yatsenko/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-like-drinking-plain-water-10-healthy-ideas-for-staying-hydrated-this-summer-191859">Don’t like drinking plain water? 10 healthy ideas for staying hydrated this summer</a>
</strong>
</em>
</p>
<hr>
<h2>5 ways to beat the heat while pregnant</h2>
<p>Evidence of the effectiveness of interventions that address acute heat exposure during pregnancy specifically are limited. Air-conditioning is exceptionally protective, however it is unaffordable for many in Australia and globally. </p>
<p>More evidence of the effect of extreme heat on pregnancy outcomes at a population level in both low and high income countries will help us develop ways to protect pregnant people and the community. </p>
<p>In the meantime, with the threat of more very hot summer days, simple strategies to <a href="https://www.health.nsw.gov.au/environment/beattheheat/pages/default.aspx">beat the heat</a> when pregnant include:</p>
<p><strong>1) Drink enough water</strong> – take a water bottle with you when out and about</p>
<p><strong>2) Plan your day</strong> – avoid the hottest part of the day if you can. Take a hat or umbrella with you for shade</p>
<p><strong>3) Stay cool</strong> – use fans or air-conditioning if possible, close blinds and curtains, visit a cooled public environment </p>
<p><strong>4) Dress down</strong> – wear lightweight, long-sleeved, light-coloured, loose-fitting clothes made from natural fibres, such as cotton or linen</p>
<p><strong>5) Go to sleep on your side</strong> – at night and for daytime naps to allow the <a href="https://theconversation.com/five-ways-to-reduce-the-risk-of-stillbirth-108253">best blood flow to the baby</a>.</p>
<p>These strategies need to be adapted to personal circumstances, and of course seek medical advice if you feel unwell. Signs of heat exhaustion that can lead to <a href="https://www.healthdirect.gov.au/heatstroke">heat stroke</a> if not treated early include:</p>
<ul>
<li>sweating and pale, cool, damp skin</li>
<li>dizziness and weakness</li>
<li>a headache</li>
<li>nausea or vomiting</li>
<li>a rapid pulse and fast, shallow breathing</li>
<li>muscle cramps </li>
<li>fainting</li>
<li>feeling restless and anxious</li>
<li>heat rash.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-extremely-hot-and-im-feeling-weak-and-dizzy-could-i-have-heat-stroke-215084">It's extremely hot and I'm feeling weak and dizzy. Could I have heat stroke?</a>
</strong>
</em>
</p>
<hr>
<p>If you have these symptoms, find a cool place to rest, drink cool water or a rehydration drink, remove excess clothing, have a cool shower or bath, or sit for a while with your feet in cool water.</p>
<p>More severe symptoms indicating heatstroke include intense thirst, slurred speech, lack of coordination or confusion, and aggressive or strange behaviour. Heatstroke is a medical emergency, so call triple 0.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-to-reduce-the-risk-of-stillbirth-108253">Five ways to reduce the risk of stillbirth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/217368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrienne Gordon receives funding from MRFF, NHMRC and Wellcome Trust. She is affiliated with the International Stillbirth Alliance, the NHMRC Stillbirth Centre of Research Excellence, The Perinatal Society of Australia and New Zealand, The Sydney Institute for Women, Children and their Families, Womens Healthcare Australasia and RedNose Australia. </span></em></p><p class="fine-print"><em><span>Camille Raynes-Greenow receives funding from NHMRC, Wellcome Trust, ERLA, UK. </span></em></p><p class="fine-print"><em><span>Ollie Jay receives funding from National Health and Medical Research Council, Wellcome Trust, NSW Health, NSW Dept of Planning, Industry and Environment, and the NSW Reconstruction Authority (formerly Resilience NSW), Tennis Australia.</span></em></p>During pregnancy, the body’s capacity to regulate temperature changes. Here’s how to cool down and the overheating red flags to watch out for.Adrienne Gordon, Neonatal Staff Specialist, NHMRC Early Career Research Fellow, University of SydneyCamille Raynes-Greenow, Professor and Deputy Head of School, Sydney School of Public Health, University of SydneyOllie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193142024-01-22T19:04:26Z2024-01-22T19:04:26ZSymptoms of menopause can make it harder to work. Here’s what employers should be doing<figure><img src="https://images.theconversation.com/files/570525/original/file-20240122-19-v8becu.jpg?ixlib=rb-1.1.0&rect=5%2C68%2C3828%2C2086&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-worrying-office-2134006553">metamorworks/Shutterstock</a></span></figcaption></figure><p>How menopause affects women’s working lives has been shrouded by stigma for decades. </p>
<p>But this is starting to change. Australian journalist Imogen Crump’s recent on-air hot flush and her remark “I don’t think hormones respect national television” drew applause for its candour. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/futurewomen/reel/CzaMFcrP7vA","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>The federal parliament has menopause firmly on its radar with an <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Menopause">inquiry</a> set to explore the economic, physical, mental and emotional effects of this typically natural transition. </p>
<p>The inquiry will also investigate why awareness, availability and usage of workplace supports remains low. It’s not enough for employers to offer supports – employees need to be confident enough to access them. </p>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/37998437/">global review</a> of organisational supports for menstruation and menopause found workplaces play a pivotal role in breaking menopausal taboos. With the right interventions, workplaces can enable employees to manage their symptoms and remain in the workforce.</p>
<h2>3 in 4 women experience troubling symptoms</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK507826/#:%7E:text=Menopause%20is%20a%20routine%2C%20non,age%20of%20menopause%20is%2051.">Menopause</a> is when a woman or person who menstruates stops having their period for at least 12 months. </p>
<p>Most people who menstruate transition to menopause and <a href="https://www.healthdirect.gov.au/menopause#:%7E:text=Symptoms%20during%20menopause%20include%20changes,tender%20breasts%20and%20emotional%20changes">experience</a> perimenopausal symptoms between 45 and 60 years of age. </p>
<p>Symptoms <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/inm.13271">commonly include</a> hot flushes, night sweats, cognitive disruptions known as “brain fog”, anxiety, depressive symptoms and disturbed sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/perimenopause-usually-begins-in-your-40s-how-do-you-know-if-it-has-started-215806">Perimenopause usually begins in your 40s. How do you know if it has started?</a>
</strong>
</em>
</p>
<hr>
<p>For <a href="https://www.jeanhailes.org.au/uploads/03-Charts-and-checklists-TGD/Perimenopause-and-menopause-symptom-checklist_TGD.pdf">some people</a>, menopausal symptoms can be brief and cause little discomfort. But <a href="https://pubmed.ncbi.nlm.nih.gov/28539167/">around</a> 25% of women experience symptoms that profoundly affect their daily <a href="https://pubmed.ncbi.nlm.nih.gov/28539167/">working lives</a>. </p>
<h2>Why menopause is a workplace issue</h2>
<p>The government’s focus on prolonging workforce participation, together with its workplace equality agenda, has placed menopause on the agenda for <a href="https://www.australianunions.org.au/factsheet/menopause-in-the-workplace/">unions</a> and <a href="https://www.abc.net.au/news/2023-10-18/menopause-womens-health-policy-in-workplaces/102976708">individual organisations</a>. </p>
<p>Recent Australian <a href="https://retailpharmacymagazine.com.au/new-research-reveals-impact-of-menopause-symptoms-on-australian-women/">research</a> found 17% of women aged 45 to 64 reported taking an extended break from work in the last five years.</p>
<p>Menopause can also be a key factor in some women’s decision to <a href="https://www.theguardian.com/society/2020/aug/06/female-doctors-in-menopause-retiring-early-due-to-sexism-says-study">retire early</a>. Women retire 7.4 years earlier, on average, than men. This means a <a href="https://www.abc.net.au/news/2023-04-09/menopause-in-the-workplace-and-the-push-for-more-help-for-women/102192986">loss of earnings</a> upwards of A$577,512 per woman.</p>
<p>The economic impact is significant. Menopause is estimated to <a href="https://treasury.gov.au/sites/default/files/2023-03/c2023-379612-australian_institute_of_superannuation_trustees.pdf">cost</a> Australian women $15.2 billion in lost income and superannuation for every year of early retirement. </p>
<figure class="align-center ">
<img alt="Female scientist looks at computer" src="https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570527/original/file-20240122-19-va5mdg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in six midlife women in Australia took an extended break from work.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cuttingedge-computer-innovation-research-lab-revolutionizes-2389748863">Andrey_Popov/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Changing workplace culture is key</h2>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/37998437/">review</a> investigated the supports organisations around the globe are offering for women going through menopause. Organisations have trialled a wide range of interventions, with varying success.</p>
<p>The better ones took a holistic approach. They prioritised a safe and open workplace culture, where menopausal symptoms could be talked about. Awareness raising, <a href="https://www.sciencedirect.com/science/article/pii/S0378512213002235">education</a> and buy-in from senior leaders contributed to a positive workplace culture. </p>
<p>Without this, employees can fear repercussions will impact their job security or career progression and are likely to be <a href="https://www.fairwork.gov.au/tools-and-resources/best-practice-guides/flexible-working-arrangements#:%7E:text=All%20responses%20to%20flexible%20working,when%20responding%20to%20the%20request">suffering in silence</a>.</p>
<h2>Collaboration and adaptability is key</h2>
<p>It’s important for employees and employers to <a href="https://www.sustainability.vic.gov.au/news/news-articles/sv-introduces-leave-for-menstruation-and-menopause">work together</a> to develop evidence-based workplace guidelines. These should include actionable advice about how to modify working conditions. </p>
<p>Guidelines supporting staff can be better received than policies as they can be less bureaucratic and more practical. Menopause guidelines might recommend access to: </p>
<ul>
<li>flexible working conditions</li>
<li>fans</li>
<li>cold drinking water</li>
<li>natural light</li>
<li>free period products </li>
<li>uniforms made from breathable, natural fabrics. </li>
</ul>
<p>Guidelines must be adapted to different industries, professions and work roles. Ways of cooling down employees will be more necessary for hot workplaces such as commercial kitchens or labour intensive roles in agriculture and construction. </p>
<p>Guidelines within the <a href="https://www.diverseeducators.co.uk/menopause-in-education-the-impact-on-the-teaching-profession/">teaching profession</a>, in contrast, might include more access to toilet breaks and on-site showering facilities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-design-menopause-leave-policies-that-really-support-women-in-the-workplace-209282">How to design menopause leave policies that really support women in the workplace</a>
</strong>
</em>
</p>
<hr>
<p>Flexible working conditions, including flexible start and finish times, more frequent breaks and working from home can also be useful during symptom flare ups. Australian <a href="https://www.fairwork.gov.au/tools-and-resources/best-practice-guides/flexible-working-arrangements#:%7E:text=All%20responses%20to%20flexible%20working,when%20responding%20to%20the%20request.">legislation</a> already enables these supports, but their take-up is often tied to senior management support. </p>
<figure class="align-center ">
<img alt="Woman works at desk at home" src="https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570528/original/file-20240122-19-21lmwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It can be useful to work from home when symptoms flare up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-woman-working-her-home-office-1480643471">pixelheadphoto digitalskillet/Shutterstock</a></span>
</figcaption>
</figure>
<p>Additional leave entitlements, combined with education and the other interventions mentioned can be effective, but remain widely debated. </p>
<p>Some <a href="https://www.smh.com.au/national/paid-leave-for-periods-and-menopause-will-improve-gender-equality-20210527-p57vsf.html">argue</a> additional entitlements can lead to menopausal women being seen as weak or unreliable. </p>
<p>But in the right circumstances, leave provisions can enable employees to take time away from work they need to better manage their symptoms and return to work fresh. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9011865/">Best-practice</a> approaches also recognise how other health issues like pelvic pain (such as endometriosis) and <a href="https://www.westernsydney.edu.au/newscentre/news_centre/more_news_stories/whats_the_bloody_big_deal_how_australian_workplaces_and_educational_institutions_can_help_break_the_menstrual_taboo">menstruation</a> can affect employees throughout their life-course. </p>
<h2>Lagging workplaces need to catch up</h2>
<p><a href="https://www.vwt.org.au/menstrual-and-menopause-wellbeing-policy/">Victorian Women’s Trust</a>, <a href="https://www.futuresuper.com.au/blog/a-bloody-good-policy/">Future Super</a> and ModiBodi were among the first Australian organisations to offer support to employees affected by menopause and menstruation. These organisations offer a variety of workplace supports that trust employees to be honest about their circumstances and empower them to access help when they need it.</p>
<p>With a tight employment market and a workforce motivated by progressive corporate cultures, more organisations may be encouraged to consider a menstrual and menopause policy. Sustainability Victoria recently topped the 2023 AFR Boss Best Places to Work List (in the government, education and not-for-profit sector) in part due to its progressive <a href="https://www.sustainability.vic.gov.au/news/news-articles/sv-introduces-leave-for-menstruation-and-menopause">menstruation and menopause policy</a>. </p>
<p>Organisations looking to implement menopause-sensitive workplace policies need not reinvent the wheel. Research-informed, free workplace resources can <a href="https://www.menopauseatwork.org/free-resources">encourage productive conversations</a>. They can be modified to meet unique industry and workplace contexts, with leading workplaces often <a href="https://www.vwt.org.au/menstrual-and-menopause-wellbeing-policy/#:%7E:text=This%20policy%20supports%20employees%20in,taboo%20surrounding%20menstruation%20and%20menopause">sharing</a> their guidelines and policies to help break the stigma and taboo shrouding menstruation and menopause in the workplace.</p>
<p>If we are serious about workplace gender equity, workplace menopause supports should be part of business as usual. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">How long does menopause last? 5 tips for navigating uncertain times</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/219314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle O'Shea receives funding from Endometriosis Australia & Changing Places HR Services Pty Ltd</span></em></p><p class="fine-print"><em><span>Danielle Howe receives funding from Western Sydney University. </span></em></p><p class="fine-print"><em><span>Sarah Duffy received funding from Endometriosis Australia & Changing Places HR Services Pty Ltd. </span></em></p><p class="fine-print"><em><span>Mike Armour 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.</span></em></p>Menopause can be a key factor in some women’s decision to retire early. But with the right interventions, workplaces can enable women to manage their symptoms and remain in the workforce.Michelle O'Shea, Senior Lecturer, School of Business, Western Sydney UniversityDanielle Howe, PhD Candidate, Western Sydney UniversityMike Armour, Associate Professor at NICM Health Research Institute, Western Sydney UniversitySarah Duffy, Senior Lecturer, School of Business, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2197072023-12-22T09:47:25Z2023-12-22T09:47:25ZMorning sickness doesn’t only occur in the morning. So why do we still call it that?<figure><img src="https://images.theconversation.com/files/565943/original/file-20231215-27-vw4i69.png?ixlib=rb-1.1.0&rect=6%2C0%2C2082%2C1384&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-young-woman-pain-stomach-vomiting-1575078391">Dragana Gordic/Shutterstock</a></span></figcaption></figure><p>As many as <a href="https://www.nps.org.au/assets/c54914225deb37a1-077be09b52f0-8b91fd8dbb1142caa58132e34b40b5466d337bd7268dda75dfae4a61d9f6.pdf">90%</a> or more of pregnant people experience some degree of nausea or vomiting, often colloquially referred to as “morning sickness”. </p>
<p>For some, it is relatively mild, coming and going during the first trimester without much fuss. For others, it can be severe, life-changing and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514078/">traumatic</a>. </p>
<p>But the term “morning sickness” is a misnomer. Findings clearly show nausea and vomiting can occur throughout the day. </p>
<p>A recent and novel <a href="https://bjgp.org/content/70/697/e534.short">study</a> had pregnant women complete a symptom diary for each hour of the day across the first seven weeks of pregnancy. It found while peak symptoms occur in the morning, almost as many women experienced symptoms in the late afternoon or night as did in the morning. </p>
<p>Frequent symptoms of nausea and vomiting can become a significant problem, impacting an individual’s health, wellbeing and ability to perform basic tasks.</p>
<p>Given nausea and vomiting in pregnancy is frequently misunderstood and its effects often underestimated, its incorrect naming contributes to the stigma and lack of effective treatments faced by many women.</p>
<h2>The severe impacts of nausea and vomiting in pregnancy</h2>
<p>The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum and is reported to affect up to <a href="https://pubmed.ncbi.nlm.nih.gov/23863575/">3.6%</a> of pregnant women. Women with hyperemesis gravidarum have severe and persistent symptoms that can make it difficult for them to eat and drink enough. It can lead to weight loss, dehydration, and nutritional deficiencies. </p>
<p>It can also have a big impact on a person’s emotional, mental and physical health. Some people might be too sick to work, look after themselves or others, or complete normal daily activities. The economic and psychosocial effects of this can be profound. </p>
<p>In addition, <a href="https://www.ajog.org/article/S0002-9378(21)00157-5/fulltext">recent studies</a> report high rates of pregnancy termination, as well as suicidal thoughts, among hyperemesis gravidarum sufferers. This is on top of the range of <a href="https://pubmed.ncbi.nlm.nih.gov/21749625/">adverse pregnancy outcomes</a> (such as low birth weight) associated with the condition. </p>
<p>Even when not considered severe enough to constitute hyperemesis gravidarum, nausea and vomiting in pregnancy can still have profound impacts, greatly impacting women’s health, mental wellbeing, work, relationships, quality of life and experience of pregnancy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman covering her mouth at the breakfast table as though she's about to be sick." src="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pregnancy sickness ranges in severity.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-feeling-nausea-during-breakfast-2193653627">Goksi/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The stigma women face</h2>
<p>While the significant burden of nausea and vomiting highlights the importance of early and effective treatment, the reality faced by many women paints a different picture. A recent <a href="https://pubmed.ncbi.nlm.nih.gov/33984156/">Australian survey</a> found one in four respondents reported being denied medications for treating nausea or hyperemesis. </p>
<p>In part, this could reflect the ongoing hesitancy towards using medications during pregnancy since the <a href="https://theconversation.com/thalidomide-survivors-are-receiving-an-apology-for-the-pharmaceutical-disaster-that-changed-pregnancy-medicine-218691">thalidomide tragedy</a> in the 1960s. But it also reflects the enduring stigma those experiencing nausea and vomiting in pregnancy face when trying to receive care.</p>
<p>As recently as the early 1900s, the root cause of nausea and vomiting in pregnancy was thought to be psychological. Journal articles referred to “<a href="https://history-of-obgyn.com/uploads/3/5/4/8/35483599/1905-stevens-hyperemesis_obs-rev-jun2015.pdf">hysteria</a>” as a principal cause of nausea and vomiting, and of individuals <a href="https://pubmed.ncbi.nlm.nih.gov/13289940/">manifesting</a> symptoms as a result of being unhappy with their pregnancy or marriage, or seeking attention.</p>
<p>These erroneous beliefs have led to various dismissive and damaging practices resulting in women feeling isolated and unsupported. A <a href="https://pubmed.ncbi.nlm.nih.gov/15550881/">2004 French study</a> reported treating women admitted to hospital for hyperemesis gravidarum by subjecting them to isolation from friends or family to see if they would reveal their “secret desire” for an abortion.</p>
<p><a href="https://news.cornell.edu/stories/2000/05/morning-sickness-protects-mothers-and-their-unborn">Biologists</a> have argued nausea and vomiting in pregnancy serves a beneficial function to protect mothers and their unborn children from potentially harmful exposures. In part, this is based on evidence those experiencing nausea and vomiting in pregnancy are <a href="https://pubmed.ncbi.nlm.nih.gov/2611170/">less likely to have a miscarriage</a>.</p>
<p>While it seems to be accurate that nausea and vomiting in pregnancy has benefits, this argument presents it as a “rite of passage” and something individuals should welcome, while trivialising its associated burden.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thalidomide-survivors-are-receiving-an-apology-for-the-pharmaceutical-disaster-that-changed-pregnancy-medicine-218691">Thalidomide survivors are receiving an apology for the pharmaceutical disaster that changed pregnancy medicine</a>
</strong>
</em>
</p>
<hr>
<h2>How should nausea and vomiting in pregnancy be defined?</h2>
<p>While nausea and vomiting in pregnancy is common, when prolonged it can quickly become a debilitating medical condition. It’s important individuals experiencing nausea and vomiting in pregnancy are listened to and get the treatment they need, rather than being dismissed. </p>
<p><a href="https://www.somanz.org/content/uploads/2023/12/SOMANZ-Management-of-NVP-ExecSummary-Updated-Oct-2023-FINAL.pdf">Guidelines</a> often recommend using screening tools which classify individuals as having mild, moderate or severe nausea and vomiting based on responses to three questions about how they have been feeling over the past 24 hours. </p>
<p>While tools like this can be useful to guide or monitor treatment, they can risk causing further harm if used to restrict access to care based on perceived symptom severity. It’s crucial that treatment decisions not be based solely on a number, but rather on a comprehensive evaluation of an individual’s emotional, mental and physical health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant stomach" src="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pregnancy sickness should be seen as an illness to be managed, not a rite of passage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-pregnant-woman-touching-her-2115089237">SeventyFour/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Time to retire the term ‘morning sickness’</h2>
<p>A term that incorrectly describes the nature and spectrum of an illness can be expected to further perpetuate stigmas faced by those seeking clinical care. Given it’s well recognised the term is felt by many to downplay the condition, we must ask ourselves why we continue to use the term “morning sickness”. </p>
<p>This description is inaccurate, simplistic, and therefore unhelpful. Referring to the illness by what it is, nausea and vomiting in pregnancy or “NVP”, could reduce stigma and lead to better outcomes for sufferers.</p>
<p>Perhaps more important is recognition that not all nausea and vomiting in pregnancy is experienced equally, and treating it as such risks trivialising the experience of each individual.</p><img src="https://counter.theconversation.com/content/219707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luke Grzeskowiak receives funding from the Channel 7 Children's Research Foundation, The Hospital Research Foundation and National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Hannah Jackson receives an Australian Government Research Training Program Stipend from the University of Technology Sydney.</span></em></p>We know nausea and vomiting is common all times of day during pregnancy. Calling it morning sickness contributes to the stigma and misunderstanding of the condition.Luke Grzeskowiak, Fellow in Medicines Use and Safety, Flinders UniversityHannah Jackson, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183442023-12-21T23:19:57Z2023-12-21T23:19:57ZGot period pain or cramps? What to eat and avoid, according to science<figure><img src="https://images.theconversation.com/files/566750/original/file-20231219-27-7x7oaq.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938362/">Sora Shimazaki/Pexels</a></span></figcaption></figure><p>Painful periods are common. More than half of people who menstruate have some pain for up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">three days a month</a>, typically throbbing or cramping in the lower abdomen. </p>
<p>Digestive changes – such as vomiting, gas, bloating, diarrhoea and a “bubbling gut” – are also <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0538-8">common</a> around the time of menstruation. </p>
<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">treatments</a> for period pain (known medically as dysmenorrhoea). Not all these treatments are well-tolerated or work for everyone.</p>
<p>We’re learning more about food’s role in influencing <a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">inflammation</a> in our body. So, could eating or avoiding certain foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963185/">help</a> with painful periods? Here’s what we know based on high-quality research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may relieve period pain or cramps</h2>
<p><strong>Foods containing omega-3 fatty acids</strong></p>
<p>Foods rich in omega-3 fatty acids include chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters and edamame beans. Omega-3 fatty acids are naturally present in oils including fish, cod liver, algal, krill, flaxseed (linseed), soybean and canola oils.</p>
<p>Omega-3 fatty acids <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/">affect</a> how our cells function and the signalling pathways associated with inflammation and pain. </p>
<p>Earlier this year, researchers published a <a href="https://pubmed.ncbi.nlm.nih.gov/37545015/#:%7E:text=Meta%2Danalysis%20(n%20%3D%208,0.51)%20at%20reducing%20dysmenorrhoea%20pain.">meta-analysis</a> where they combined and analysed all data available on the impact of omega-3 fatty acids on period pain. They found diets high in omega-3 fatty acids (including supplements of 300-1,800 milligrams a day) over two to three months may reduce pain, and pain medication use, in people with painful periods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open sardine can, parsley, cut lemon on wooden table." src="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sardines and other oily fish are rich in omega-3 fatty acids.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/open-can-sardines-preserves-oil-on-1636046179">BearFotos/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-fish-oil-supplements-as-healthy-as-we-think-and-is-eating-fish-better-212250">Are fish oil supplements as healthy as we think? And is eating fish better?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin D</strong></p>
<p>Foods high in vitamin D include trout, salmon, tuna and mackerel, as well as fish liver oils. Small amounts are also found in beef liver, egg yolk and cheese. Mushrooms contain varying levels of vitamin D, and you can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/">boost</a> this by exposing them to direct midday sunlight for 15-120 minutes. </p>
<p>The body can make vitamin D when it gets sunlight exposure and you can also get vitamin D from supplements.</p>
<p>Vitamin D <a href="https://pubmed.ncbi.nlm.nih.gov/24262718/">may help</a> reduce the factors that cause inflammation in the uterus. This includes levels of hormone-like molecules called prostaglandins. </p>
<p>A 2023 <a href="https://www.mdpi.com/2072-6643/15/13/2830#B11-nutrients-15-02830">meta-analysis</a> showed women who received weekly doses of vitamin D greater than 50,000 IU (or international units) had relief from period pain, regardless of how long and how often women took the vitamin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin E</strong></p>
<p>Foods rich in vitamin E include seeds (particularly sunflower seeds), nuts (particularly almonds, hazelnuts and peanuts) and spinach, broccoli, kiwifruit, mango and tomato. </p>
<p>There is some evidence vitamin E supplements reduce period pain. In a well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/15777446/">trial</a> run over the course of four periods, women took vitamin E supplements (90 milligrams, twice a day) for five days, beginning two days before the expected start of the period. This significantly reduced the severity and duration of period pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman tipping out nut mix into palm of hand" src="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Seeds and nuts are rich in vitamin E.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-jar-nuts-dried-fruits-1112521214">NazarBazar/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may worsen period pain or cramps</h2>
<p><strong>Highly processed foods</strong></p>
<p>Highly processed foods include energy-dense, nutrient-poor foods such as takeaways, chips, biscuits, doughnuts, processed meats and soft drinks. </p>
<p>Research findings on the impact of a diet high in processed foods on period pain vary. A 2019 <a href="https://karger.com/goi/article/84/3/209/153726/Nutrition-as-a-Potential-Factor-of-Primary">review</a> found sugar consumption had little association with painful periods. </p>
<p>However, some observational studies (which do not involve an intervention) suggest women who eat more processed foods may have more intense period pain. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/19468949/">2009 study</a> found adolescent females who ate fast or processed foods for two days or more a week reported more period pain compared with those who did not. Therefore, eating less processed food may be something to consider. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<p><strong>Caffeine</strong></p>
<p>Foods high in caffeine include coffee, energy drinks and some processed energy bars. Caffeine intake is <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwij7LmPxfSCAxV5d_UHHRnyDyUQFnoECBIQAQ&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4222008%2F&usg=AOvVaw2mEjyMadOB1D6geQgAwckc&opi=89978449">associated with</a> menstrual pain. </p>
<p>Although we don’t know the precise underlying mechanism, researchers think caffeine may narrow blood vessels, which limits blood flow, leading to stronger cramps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired woman staring at bowl of breakfast, cereal and cup on kitchen table" src="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding coffee may help your period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-does-not-want-eat-her-151886987">Lolostock/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">Nope, coffee won't give you extra energy. It'll just borrow a bit that you'll pay for later</a>
</strong>
</em>
</p>
<hr>
<p><strong>Alcohol</strong></p>
<p>Drinking alcohol is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859868/">not</a> a recognised risk factor for painful periods. However, chronic heavy alcohol use reduces levels of <a href="https://academic.oup.com/alcalc/article/55/2/164/5734241">magnesium</a> in the blood. Magnesium is an important factor in relaxing muscles and supporting blood flow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
</strong>
</em>
</p>
<hr>
<h2>A healthy, balanced diet is your best best</h2>
<p>Having a healthy, balanced diet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">one of the best ways</a> we can support our own health and prevent future chronic conditions. This can help reduce inflammation in our bodies, thought to be the main way diet can help people with painful periods.</p>
<p>If you are looking for tailored dietary advice or a menstrual health meal plan, speak with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitian</a>.</p>
<p>It’s important to stress, however, that diet alone cannot treat all forms of menstrual pain. So if you are concerned about your painful periods, check in with your GP who can discuss your options.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
</strong>
</em>
</p>
<hr>
<p><em>This article has been updated to reflect the correct date of a review that found sugar consumption had little association with painful periods.</em></p><img src="https://counter.theconversation.com/content/218344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch is an Accredited Practising Dietitian and member of Dietitians Australia. She works for Southern Cross University. </span></em></p><p class="fine-print"><em><span>Pui Ting Wong is a PhD Candidate at The University Queensland (UQ) Centre for Community Health and Wellbeing, and receives the UQ Tuition Fee Offset and Stipend Scholarship. She is also an Accredited Practising Dietitian and a member of Dietitians Australia.</span></em></p>A cup of coffee might help you kick-start your day, but it may actually make painful periods worse. Here’s what else to avoid (and eat) if you have period pain.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Lecturer, Southern Cross UniversityPui Ting Wong, PhD Candidate, culinary education and adolescent mental health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2121982023-12-20T00:14:19Z2023-12-20T00:14:19ZWhat happens to your vagina as you age?<figure><img src="https://images.theconversation.com/files/565380/original/file-20231213-23-r8q3y2.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3000%2C2276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/realistic-3d-paper-cut-human-uterus-2210475317">Dedraw Studio/Shutterstock</a></span></figcaption></figure><p>The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.</p>
<p>Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.</p>
<p>Here’s what happens to your vagina as you age, whether you notice or not.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-grey-haired-and-radiant-reimagining-ageing-for-women-182336">Friday essay: grey-haired and radiant – reimagining ageing for women</a>
</strong>
</em>
</p>
<hr>
<h2>Let’s clear up the terminology</h2>
<p>We’re focusing on the <a href="https://www.ncbi.nlm.nih.gov/books/NBK545147/">vagina</a>, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of female reproductive system including the vagina" src="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565381/original/file-20231213-17-grlu25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We’re talking about the internal organ, the vagina.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/female-reproductive-system-image-diagram-243154639">Suwin66/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vulvas-periods-and-leaks-women-need-the-right-words-to-seek-help-for-conditions-down-there-53638">Vulvas, periods and leaks: women need the right words to seek help for conditions 'down there'</a>
</strong>
</em>
</p>
<hr>
<h2>What happens to the vagina as you age?</h2>
<p>Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause. </p>
<p>Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. <a href="https://www.ncbi.nlm.nih.gov/books/NBK564341/">Effects</a> may include:</p>
<ul>
<li>less vaginal secretions, potentially leading to dryness </li>
<li>less growth of vagina surface cells resulting in a thinned lining</li>
<li>alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing</li>
<li>fewer blood vessels around the vagina, which <a href="https://pubmed.ncbi.nlm.nih.gov/2989746/">may explain</a> less blood flow after menopause</li>
<li>a <a href="https://www.nature.com/articles/s41564-022-01083-2">shift</a> in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline. </li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
</strong>
</em>
</p>
<hr>
<h2>What symptoms can I expect?</h2>
<p>Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women. </p>
<p>Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136974/pdf/nihms957122.pdf">one study</a>, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two cut grapefruit, one drier than the other" src="https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562316/original/file-20231129-21-kae382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaginal dryness is common but it can also affect younger women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fresh-grapefruit-stale-on-pink-background-1115302421">ECOSY/Shutterstock</a></span>
</figcaption>
</figure>
<p>Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">How long does menopause last? 5 tips for navigating uncertain times</a>
</strong>
</em>
</p>
<hr>
<h2>Not everyone has the same experience</h2>
<p>Women vary in whether they notice vaginal changes and whether they <a href="https://www.flinders.edu.au/research/vitalmeno">are bothered</a> by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.</p>
<p>In fact, <a href="https://www.imsociety.org/2021/06/21/a-core-outcome-set-for-vasomotor-symptoms-associated-with-menopause-the-comma-core-outcomes-in-menopause-global-initiative/">researchers globally</a> are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaginas-pheromones-and-tiktok-what-is-the-strange-new-trend-of-vabbing-187431">Vaginas, pheromones and TikTok: what is the strange new trend of 'vabbing'?</a>
</strong>
</em>
</p>
<hr>
<h2>If symptoms bother you</h2>
<p>Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy. </p>
<p>While there are many small clinical trials of individual products, these studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942543/">lack the power</a> to demonstrate if they are really effective in improving vaginal symptoms. </p>
<p>In contrast, there is robust evidence that vaginal oestrogen is <a href="https://www.cochrane.org/CD001500/MENSTR_use-postmenopausal-women-creams-pessaries-or-vaginal-ring-apply-oestrogen-vaginally-symptoms-vaginal">effective</a> in treating vaginal dryness and reducing pain during sex. It also <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005131.pub2/full">reduces</a> your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription. </p>
<p>Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is <a href="https://pubmed.ncbi.nlm.nih.gov/31913230/">generally safe</a> but longer-term trials are required to confirm safety in long-term use beyond a year. </p>
<p>Women with a <a href="https://www.menopause.org.au/hp/position-statements/the-use-of-vaginal-estrogen-in-women-with-a-history-of-estrogen-dependent-breast-cancer">history of breast cancer</a> should see their oncologist to discuss using oestrogen as it may not be suitable for them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-vagina-cleans-itself-why-vagina-cleaning-fads-are-unnecessary-and-harmful-88150">Your vagina cleans itself: why vagina cleaning fads are unnecessary and harmful</a>
</strong>
</em>
</p>
<hr>
<h2>Are there other treatments?</h2>
<p>New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.</p>
<p>For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/29381086">small number of reports</a> show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-healthy-people-take-probiotic-supplements-95861">Health Check: should healthy people take probiotic supplements?</a>
</strong>
</em>
</p>
<hr>
<h2>Where to from here?</h2>
<p>The normal ageing process, as well as menopause, both affect the vagina as we age.</p>
<p>Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress. </p>
<p>While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.</p>
<hr>
<p><em>Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/212198/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martha Hickey previously received research funding for a study of an ultrasound device for vaginal dryness (Madorra)</span></em></p><p class="fine-print"><em><span>Louie Ye 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.</span></em></p>Dryness, irritation, or pain during sex can be managed. But not everyone has these symptoms or is bothered by them.Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of MelbourneMartha Hickey, Professor of Obstetrics and Gynaecology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196632023-12-14T13:19:15Z2023-12-14T13:19:15ZWe think we have found a cause of pregnancy sickness, and it may lead to a treatment<figure><img src="https://images.theconversation.com/files/565507/original/file-20231213-19-swroox.jpg?ixlib=rb-1.1.0&rect=48%2C0%2C5351%2C3540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnancy sickness is believed to affect 7 in 10 women. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-suffering-morning-sickness-bathroom-home-1041217495">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Sickness in pregnancy, or hyperemesis gravidarum, is common and is thought to <a href="https://journals.lww.com/obgynsurvey/abstract/2013/09001/the_impact_of_nausea_and_vomiting_of_pregnancy_on.1.aspx">affect</a> seven out of ten women at some time in their pregnancy. But, until recently, very little has been known about why it happens. </p>
<p><a href="https://www.nature.com/articles/s41586-023-06921-9">New research</a> by our team has identified sensitivity to a hormone made in abundance by the developing pregnancy, GDF15, as a contributor to the risk of pregnancy sickness.</p>
<p>This condition can affect pregnant women’s quality of life, even in so-called mild cases. Between 1% and 3% of women <a href="https://pubmed.ncbi.nlm.nih.gov/31515515/">suffer</a> from a severe form of pregnancy sickness when nausea and vomiting are so severe that they lose weight or become dehydrated, or both. In one study, this condition was the most common reason that women were admitted to <a href="https://pubmed.ncbi.nlm.nih.gov/12100809/">hospital</a> in the first three months of pregnancy. </p>
<p>It has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/ppe.12416">associated</a> with worse pregnancy outcomes and its effect lasts beyond the end of pregnancy with some women <a href="https://pubmed.ncbi.nlm.nih.gov/21635201/">reporting</a> psychological distress and being reluctant to <a href="https://pubmed.ncbi.nlm.nih.gov/28241811/">conceive again</a>. </p>
<p>The fact that it develops in early pregnancy and invariably resolves when pregnancy ends strongly suggests that the cause of the sickness comes from the developing pregnancy. But the detail on how and why it happens has remained elusive. This dearth of understanding makes the development of treatments difficult and arguably contributes to the considerable <a href="https://www.pregnancysicknesssupport.org.uk/documents/research%20papers/stigma-of-hg.pdf">stigma</a> associated with this condition. </p>
<h2>GDF15</h2>
<p>GDF15 is a hormone that suppresses food intake in mice by acting, probably exclusively, on a small group of cells at the base of the brain which are also known to induce nausea and vomiting. As such, GDF15 has been under investigation as an <a href="https://pubmed.ncbi.nlm.nih.gov/36754014/">obesity therapy</a>. </p>
<p>Early trials confirm it suppresses appetite in people, but it also causes <a href="https://pubmed.ncbi.nlm.nih.gov/36630958/">nausea and vomiting</a>. It has long been known that it is abundant in human placenta and is present at very high concentrations in the blood of healthy pregnant women. These factors make it a plausible cause, but a detailed understanding of if GDF15 affects the severity of sickness in pregnancy has been lacking. </p>
<p>We used a variety of methods to study how GDF15 increases the risk of pregnancy sickness. We measured GDF15 in the blood of pregnant women attending hospital due to sickness and those attending hospital for other reasons. </p>
<p>We found that women with pregnancy sickness did indeed have higher levels of GDF15. While this was in keeping with GDF15 contributing to the condition, levels of GDF15 in each group overlapped substantially. This suggests that factors other than the absolute amount of GDF15 coming from the developing pregnancy might determine the risk of sickness.</p>
<p>Natural variation in DNA of future mothers contributes to risk of pregnancy sickness. Previous <a href="https://pubmed.ncbi.nlm.nih.gov/29563502/">studies</a> have identified changes in DNA near GDF15 as the biggest determinants of risk of pregnancy sickness. In particular, one rare genetic mutation (present in around one in 1,500 people) that affects the make-up of the GDF15 protein in the blood, has a large <a href="https://pubmed.ncbi.nlm.nih.gov/35218128/">effect</a> on that risk. </p>
<p>To understand the potential impact of this genetic variant on GDF15 levels in the bloodstream, we studied its effects on the protein in lab-grown cells. We discovered that this mutated GDF15 molecule gets stuck inside cells. What’s more, it actually stuck to and trapped “normal” GDF15 – this creates a double hit that hinders the transport of GDF15 out of cells. Healthy people with this mutation have markedly lower levels of GDF15 in their blood, which is consistent with these findings.</p>
<figure class="align-center ">
<img alt="A pregnant woman sits on the edge of a bed clutching her bump." src="https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Between 1% and 3% of women suffer from a severe form of pregnancy sickness.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-sitting-on-bed-holding-310309151">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>We discovered that DNA changes near GDF15, which are prevalent in about 15 to 30% of people, lower the levels of the hormone. These changes increase the risk of pregnancy sickness by small amounts. Conversely, women with the blood disorder <a href="https://www.nhs.uk/conditions/thalassaemia/">thalassaemia</a>, who have very high levels of GDF15 throughout life, actually reported much less nausea and vomiting in pregnancy.</p>
<h2>A roadmap to treatment</h2>
<p>The conclusion of these studies is clear –- predisposition to higher levels of GDF15 when not pregnant reduces the risk of pregnancy sickness. At first glance, this is rather perplexing because how can having higher levels of a hormone that makes you sick protect against pregnancy sickness? </p>
<p>In fact, several hormone systems exhibit a phenomenon resembling memory, where the sensitivity to a hormone is influenced by previous exposure to that hormone. This seemed like the most plausible explanation for our results. Supporting this theory, mice with persistently high levels of GDF15 in their bloodstream were relatively unresponsive to an acute surge in GDF15 levels. </p>
<p>Our findings suggest that lower levels of GDF15 before pregnancy result in women being hypersensitive to the large amounts of GDF15 being released from the developing pregnancy. This poses two obvious approaches to treatment of this condition –- desensitising women to GDF15 by increasing its levels before pregnancy or blocking its action during pregnancy. </p>
<p>The challenge now is to develop and test strategies to achieve these aims that are safe and acceptable to women at risk from this debilitating condition.</p><img src="https://counter.theconversation.com/content/219663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Lockhart is supported by a Wellcome Trust Clinical PhD Fellowship (225479/Z/22). SL is a named creator of a pending patent application relating to therapy for hyperemesis gravidarum filed by Cambridge Enterprise Limited (GB application No. 2304716.0; Inventor: Professor Stephen O’Rahilly.</span></em></p><p class="fine-print"><em><span>Stephen O'Rahilly has undertaken remunerated consultancy work for Pfizer, Third Rock Ventures, AstraZeneca, NorthSea Therapeutics and Courage Therapeutics. Part of the work in this paper is the subject of a pending patent application relating to therapy for hyperemesis gravidarum filed by Cambridge Enterprise Limited (GB application No. 2304716.0; Inventor: Professor Stephen O’Rahilly). SL and NR are named creators on this patent.</span></em></p>New research has uncovered the hormone that triggers morning sickness, offering hope for millions of women.Sam Lockhart, Wellcome Trust Clinical PhD Fellow, Institute of Metabolic Science and Medical Research Council Metabolic Diseases Unit, University of CambridgeStephen O'Rahilly, Professor and Co-Director of the Institute of Metabolic Science and Director of the Medical Research Council Metabolic Diseases Unit, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2119722023-11-09T14:15:03Z2023-11-09T14:15:03ZHow autistic parents feel about breastfeeding and the support they receive – new research<figure><img src="https://images.theconversation.com/files/550058/original/file-20230925-15-aytg7n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5020%2C3321&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost half the study's respondents found breastfeeding to be a positive experience most or all of the time. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-breastfeeding-her-newborn-child-516261334">Lolostock/Shutterstock</a></span></figcaption></figure><p>Surprisingly little is still known about autism and breastfeeding. A few years ago, <a href="https://journals.sagepub.com/doi/full/10.1177/13623613221089374">we reviewed</a> all of the research evidence and found limited information about the experiences of autistic parents – beyond highlighting that the sensory differences when breastfeeding could be very challenging for them. We also found that communication by health professionals didn’t always meet the <a href="https://www.autisticuk.org/post/autistic-mothers-experiences-of-breast-and-formula-feeding-babies-what-does-the-evidence-s">needs</a> of autistic parents.</p>
<p>So, for our newly released <a href="https://doi.org/10.1111/mcn.13581">study</a>, we asked 152 autistic parents from across the UK about their breast- and formula-feeding experiences. Some 87% of those who breastfed were strongly motivated to keep breastfeeding even if they ran into difficulties, while only 54% of all the parents we interviewed used any infant formula. This is a substantially lower rate of formula use than we’d typically see in the UK, where <a href="https://doc.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf">88% of babies</a> receive some infant formula during their first six months.</p>
<p>Almost half of our respondents found breastfeeding to be a positive or enjoyable experience most or all of the time. This included the experience of feeling bonded with their baby and enjoying learning about breastfeeding.</p>
<p>That said, many of these autistic parents described experiencing sensory difficulties, with touch-related issues being their most frequently reported challenge. These issues ranged from discomfort caused by “little hands” touching their skin, to pain from infants suckling, biting and “latching on” to the breast. </p>
<p>Some 10% of our participants expressed breastmilk all of the time. This is higher than we would expect in an average group of parents, as expressing milk for every feed is <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2012.06035.x">usually only done</a> when babies are premature or parents have returned to work. On the other hand, the feeling and sound of breast pumps could be unbearable for some of the parents we interviewed.</p>
<h2>Interoception</h2>
<p>Most people know about the five basic human senses: touch, sight, sound, smell and taste. But we also have three other senses that are just as important. The <a href="https://www.sciencedirect.com/topics/neuroscience/vestibular-system">vestibular system</a> helps us keep our balance and move around safely; <a href="https://www.sciencedirect.com/topics/neuroscience/proprioception#:%7E:text=Proprioception%20refers%20to%20the%20sense,have%20receptors%20involved%20in%20proprioception.">proprioception</a> lets us know how our muscles and joints are moving; and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/interoception">interoception</a> tells us about what is happening inside our bodies, such as our heart rate, breathing and digestion.</p>
<p>Autistic people often have <a href="https://www.sciencedirect.com/science/article/abs/pii/S073657481630096X">different interoceptive experiences</a> to non-autistic people – such as either not knowing or being acutely aware that they are hungry, thirsty or need the toilet. </p>
<p>With regard to breastfeeding, 41% of our participants who breastfed told us that their interoceptive experiences relating to the <a href="https://www.breastmilkcounts.com/breastfeeding-basics/the-let-down/">milk let-down reflex</a> (the response from your body that causes breastmilk to flow) was uncomfortable or painful always or most of the time. This included having “a feeling of dread” or the let-down reflex feeling odd in some way. One of our parents noted that “it felt like I had an old-fashioned telephone ringing in my breasts”.</p>
<h2>Adaptation strategies</h2>
<p>Whether our parents breast- or formula-fed, the intensity of babies’ frequent feeding could be overwhelming – a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-2397.2009.00684.x">well-known issue</a> among the general population of parents too. However, for autistic parents, carefully developed strategies to stay regulated and de-stress, such as going for a walk or watching an episode of a favourite TV show, could be disrupted by the busy routine of new parenthood.</p>
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<img alt="A woman looks at her phone while breastfeeding her baby." src="https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>The parents in our study had done a lot of problem-solving to reduce the sensory challenges of feeding their babies. This included adapting their clothing and distracting themselves during feeding by looking at a mobile phone, for example. </p>
<p>There is evidence that bonding is <a href="https://onlinelibrary.wiley.com/doi/10.1111/nhs.12918">not negatively impacted</a> by the use of smartphones when breastfeeding in a general population. So, these types of distraction should be encouraged for all parents who are finding breastfeeding hard but want to continue doing so.</p>
<p>While 76% of our parents had received some form of breastfeeding support, nearly three-quarters of these parents (71%) still reported feeling unsupported. Issues included there not being enough breastfeeding support available, and health professionals providing conflicting information – concerns that also found in the accounts of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13355">non-autistic parents</a>.</p>
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Read more:
<a href="https://theconversation.com/dehumanising-policies-leave-autistic-people-struggling-to-access-health-education-and-housing-new-review-202997">'Dehumanising policies' leave autistic people struggling to access health, education and housing – new review</a>
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<p>It also appears that those supporting infant feeding, such as midwives and health visitors, did not have a good understanding of autistic communication. For example, some parents felt they were not listened to or that their concerns were dismissed.</p>
<p>Furthermore, some parents felt that staff did not appear to understand the specific sensory and interoceptive differences that could affect autistic people while breastfeeding.</p>
<h2>Room for improvement</h2>
<p>Overall, our study suggests there is a need for better understanding of autism among those providing infant feeding support. The national autism training <a href="https://www.annafreud.org/training/national-autism-trainer-programme/">programme</a>, which is developed and delivered by autistic adults, aims to improve this situation across England. Ideally, similar programmes should be implemented in the other UK nations.</p>
<p>A second area for improvement is for autistic parents, their partners and other people supporting them to be aware of potential feeding issues in advance, so they can be better prepared. Our project provides a <a href="https://www.youtube.com/@AutismMenstruationToMenopause/videos">suite of videos</a>, designed and created by autistic health professionals and parents, to help provide this information in an autism-friendly way.</p><img src="https://counter.theconversation.com/content/211972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from UKRI and the Wellcome Trust. She is a non-executive director of Disability Wales. We wish to thank Prof Amy Brown, who was also part of the research team.</span></em></p><p class="fine-print"><em><span>Kathryn Williams receives funding for her PhD studentship from the Economic and Social Research Council. She is affiliated with Autistic UK CIC, where she is a voluntary non-executive director.</span></em></p><p class="fine-print"><em><span>Catrin Griffiths 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.</span></em></p>New research sheds light on how autism affects how we feed our babies, and vice versa.Aimee Grant, Senior Lecturer in Public Health and Wellcome Trust Career Development Fellow, Swansea UniversityCatrin Griffiths, Research Officer, Swansea UniversityKathryn Williams, PhD Candidate, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2125522023-09-27T14:07:13Z2023-09-27T14:07:13ZThe silence around vulval cancer means people are missing the signs that they have it<figure><img src="https://images.theconversation.com/files/550614/original/file-20230927-23-usjdyh.jpg?ixlib=rb-1.1.0&rect=26%2C33%2C4389%2C3151&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/erotic-metaphor-rose-bud-petals-resembling-2255290589">DenisZav/Shutterstock</a></span></figcaption></figure><p>Most people have heard of cervical, ovarian, and perhaps womb cancer, but there is one gynaecological cancer that is seldom mentioned: vulval cancer. </p>
<p>That silence is deadly. According to Cancer Research UK, <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/vulval-cancer#heading-Zero">69% of vulval cancers are considered preventable</a>. In late-stage cancer, the treatment may be devastating and in extreme cases can involve removing the entire vulva, so increasing awareness is vital. </p>
<p>However, taboos around genitalia mean many women and people with vulvas are unaware that they even have a vulva. Your vulva is the external part of the female genitals encompassing the labia minora and majora, clitoris and entrance to the vagina. </p>
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Read more:
<a href="https://theconversation.com/vulva-health-conditions-its-time-to-shatter-the-silence-210999">Vulva health conditions: it's time to shatter the silence</a>
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<p>Vulval cancer is considered rare, accounting for less than 1% of all new cancers in women in the UK. That does not mean it’s unimportant. <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/vulval-cancer#heading-One">Four people are diagnosed every day</a> in the UK. Mortality rates are projected to rise by 20% in the coming decades. </p>
<p>Most vulval cancers are associated with either a human papillomavirus (HPV) infection or a condition called lichen sclerosus (LS).</p>
<p>Experts thought vulval cancer was more common in older people, but incidence is increasing among younger women, probably in part because of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374790/">rising incidence of HPV infection</a>. Although a lot of people are aware that HPV can lead to cervical cancer, it is less well known that HPV can also cause other cancers, including cancers of the vulva, anus, penis and vagina. The HPV vaccine protects from all HPV-related cancer, including vulval. </p>
<p>The other main condition <a href="https://www.nhs.uk/conditions/lichen-sclerosus/">linked to vulval cancer is LS</a>, a chronic skin condition which typically causes intense itching and white or ashy patches. LS is associated with a type of pre-cancer called differentiated vulval intraepithelial neoplasia (dVIN). This type of VIN is more likely to develop into cancer than the type that develops as a result of HPV infection. </p>
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<h2>Delayed diagnosis</h2>
<p>In one <a href="https://ijgc.bmj.com/content/21/6/967">Danish study</a> comparing the diagnosis time of all gynaecological cancers, vulval cancer was found to have the longest delay. Scientists have suggested this is because its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823582/#:%7E:text=A%20delay%20in%20the%20diagnosis,decades%20%5B4%E2%80%938%5D.">symptoms are often vague</a> in the early stages. </p>
<p>However, we also know that lack of awareness of vulval conditions and a normalisation of vulval symptoms, together with shame and embarrassment, causes women to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.21777">delay help-seeking</a>. And women seeking help for vulval symptoms are too often not examined and misdiagnosed with thrush or symptoms of menopause. If you are concerned you have symptoms of vulval cancer or LS, you may need to insist on being examined. </p>
<p>We don’t currently have a screening programme for vulval cancer because it is so rare, but when you go for cervical screening you could ask the nurse to also check your vulva for any visual signs of cancer. </p>
<p><a href="https://www.nva.org/learnpatient/vulvar-self-examination/">Symptoms and signs of vulval cancer</a> include:</p>
<ul>
<li><p>persistent itch in the vulva</p></li>
<li><p>pain or soreness in the vulva</p></li>
<li><p>raised patches of skin that can be red, white, or dark</p></li>
<li><p>a lump or wart-like growth on the vulva</p></li>
<li><p>bleeding from the vulva or blood-stained vaginal discharge between periods</p></li>
<li><p>an open sore in the vulva</p></li>
<li><p>a burning pain when peeing</p></li>
<li><p>a mole on the vulva that changes shape or colour.</p></li>
</ul>
<p>If you have any of these you should seek help. But don’t panic. These symptoms might be caused by other, benign, conditions.</p>
<p>It’s important for you to become acquainted with your vulva and to understand what is normal for you. To this end, the University of Manchester has produced a resource to teach women how to do a vulval self-examination.</p>
<p>Resources such as the <a href="https://www.thegreatwallofvulva.com/">Great Wall of Vulva</a> can help women understand that vulvas come in all shapes and sizes.</p>
<h2>Treatment for vulval cancer</h2>
<p>If caught early, vulval cancer can be treated with a local excision – removing the cancerous cells and a margin of normal cells around it. However, treatment for later stage vulval cancer can be brutal. Depending on where the tumour is and how large it is, surgery could mean removal of part or all of the labia minora or labia majora (the two sets of lips that make up the most the vulval anatomy) and even the clitoris. </p>
<p>It doesn’t take a lot of imagination to understand the impact of this kind of treatment on quality of life. Recovering from vulval surgery is often a long process during which sitting is impossible: women can only stand or lie down. Lymph node removal can lead to lymphedema, painful swelling of the leg as lymph fluid builds up in the body’s tissues. Women may need to wear compression tights every day for the rest of their lives. And needless to say, sexual activity may be less appealing and less enjoyable after vulval surgery. </p>
<p>As with <a href="https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review">many health conditions</a>, vulval cancer does not affect everyone equally. Globally, the age at which women are diagnosed with vulval cancer is around <a href="https://pubmed.ncbi.nlm.nih.gov/29262943/">10-15 years younger</a> in lower income countries such as South Africa, compared to high income countries. This may be because HPV is more prevalent in South Africa. In England, vulval cancer incidence rates are <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/vulval-cancer#heading-Zero">74% higher in the most deprived groups</a>. </p>
<p>Persistent vulval symptoms should not be considered an “expected” part of having a vulva. Increased awareness could save some women from being diagnosed with later stage vulval cancer and improve survival rates. </p>
<p>We should be taking vulval itching and pain seriously, talking about vulval cancer and emphasising the importance of the HPV vaccine.</p><img src="https://counter.theconversation.com/content/212552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Rees receives funding from the Economic and Social Research Council (ESRC). </span></em></p>The little-known gynaecological cancer with a link to HPV.Sophie Rees, Research Fellow, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139352023-09-22T16:14:52Z2023-09-22T16:14:52ZIntroducing our latest e-book: Women’s Health Matters<p>Welcome to the launch of our latest e-book, <a href="https://bit.ly/3F57Pi5">Women’s Health Matters</a>. This e-book is a curated collection of the best insights, research and advice featured as part of our recent <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">six-week women-led series</a> of the same name.</p>
<p>Women’s Health Matters is a comprehensive resource designed to empower women and provide us with the information we need to make informed decisions about our health and wellbeing. </p>
<p>This e-book is a culmination of weeks of exploration into a wide range of women’s health topics, including childbirth, contraception, menstrual health, menopause, mental health, and more.</p>
<p>Our goal in launching this series was to break down barriers, foster open conversations and provide you with the tools to take charge of your health. </p>
<h2>Curated by women, for women</h2>
<p>What makes this e-book truly special is the dedicated team of female editors behind it. Drawing from our own health journeys and personal experiences, we have curated the best insights, stories and expert advice to bring you a wealth of information in one accessible place. </p>
<p>We understand the unique challenges and triumphs that women face when it comes to our health and this e-book reflects a diversity of experiences.</p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a> is a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/vulva-health-conditions-its-time-to-shatter-the-silence-210999">Vulva health conditions: it’s time to shatter the silence</a></em></p>
<p><em><a href="https://theconversation.com/birth-trauma-is-a-growing-problem-experiencing-it-myself-revealed-how-few-people-understand-it-209634">Birth trauma is a growing problem — experiencing it myself revealed how few people understand it</a></em></p>
<p><em><a href="https://theconversation.com/uks-first-successful-womb-transplant-key-questions-answered-212115">UK’s first successful womb transplant – key questions answered</a></em></p>
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<p>Within the pages of our e-book, you will find a wealth of knowledge and thought-provoking content. </p>
<p>From addressing the historical stigmatisation of menstruation to empowering women with practical advice on taking control of your cycle. </p>
<p>We tackle vital issues such as the under-representation of women in scientific research and shed light on lesser discussed subjects like the challenges faced by menopausal women seeking medical care, along with deeply personal experiences like birth trauma and late autism diagnosis. </p>
<p>We also uncover the “orgasm gap”, find out the difference between a vagina and a vulva and look at the significance of discussing women’s health in the workplace, underlining the relevance of these topics to women’s lives today.</p>
<p>As part of this series, we also took requests from readers about their own health concerns and topics they were curious about, commissioning pieces to address these issues directly. You can read more of our reader-requested articles <a href="https://theconversation.com/womens-health-matters-spotlight-on-birth-and-early-motherhood-212920">here</a>.</p>
<h2>Join The Conversation</h2>
<p>At The Conversation, we believe that understanding and knowledge have the power to transform lives and we are thrilled to present this valuable resource to you – for free.</p>
<p>We invite you to share our <a href="https://bit.ly/3F57Pi5">Women’s Health Matters e-book</a>, with anyone you think would benefit from knowing more about these topics. This is a free resource full of insights, research and advice, ready to empower women and girls (and those who love and care for them) on the path to better health and wellbeing.</p>
<p>And if you don’t already receive our free daily newsletter full of the latest news, analysis and expert opinion you can sign up <a href="https://theconversation.com/uk/newsletters/the-daily-2">here</a>. </p>
<p>Thanks for recognising that women’s health matters and for being part of this conversation.</p>
<p><em>You can download our Women’s Health Matters e-book <a href="https://bit.ly/3F57Pi5">here</a>.</em></p><img src="https://counter.theconversation.com/content/213935/count.gif" alt="The Conversation" width="1" height="1" />
Women’s Health Matters is a comprehensive resource designed to empower women and provide them with the information they need to make informed decisions about their health and wellbeing.Holly Squire, Special Projects Editor, The Conversation UKLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074502023-09-14T11:47:06Z2023-09-14T11:47:06ZMenopausal women often turn to doctors who know little about the symptoms – here’s what needs to change<p>Menopause typically occurs at some period between the ages of <a href="https://academic.oup.com/humupd/article/25/1/34/5139679">46 and 52</a>. Preceding this transition, hormonal changes can cause a myriad of physical and psychological symptoms, such as hot flushes, brain fog, mood swings and a loss of libido. </p>
<p>These symptoms not only affect the wellbeing of women, but also take a toll on the economy – <a href="https://www.sciencedirect.com/science/article/abs/pii/S002561962300112X">costing millions</a> in lost productivity each year. </p>
<p>Yet, despite its widespread impact, many medical professionals lack adequate education on menopause, leaving them ill-prepared to guide women through this transitional, important phase. </p>
<p>Even though 51% of the population will experience menopause, medical schools often overlook this crucial aspect of women’s health. A <a href="https://menopause-appg.co.uk/wp-content/uploads/2022/10/APPG-Menopause-Inquiry-Concluding-Report-12.10.22-1.pdf">2021 report</a> found that, in the UK, only 59% of medical schools included mandatory menopause education in their curriculum.</p>
<p>Instead, medical students were expected to gain menopause education while on their GP training placements. This lack of structured education has resulted in many doctors graduating without the necessary expertise to recognise and effectively treat menopause symptoms.</p>
<h2>Textbooks with little information</h2>
<p>Even medical textbooks, the primary source of knowledge for medical practitioners, often provide scant information on menopause. One <a href="https://www.sciencedirect.com/science/article/pii/S0277953611004928?via%3Dihub#sec3">study</a> revealed that 58% of analysed medical textbooks used around the world had no reference to menopause and 12% dedicated less than a paragraph to the topic. </p>
<p>When included, the textbooks often portrayed menopause as being a “failure” or the end of “normal” ovulatory function. Such language perpetuates the false notion that the post-menopausal body is somehow “broken” or “abnormal”.</p>
<p>The lack of menopause specialists means that some <a href="https://inews.co.uk/news/women-menopause-appointments-2025-2275134?ico=in-line_link">women spend years suffering</a> from menopause-related symptoms that are either misdiagnosed or insufficiently treated. It has also placed a large burden on the few clinics that do offer the service. </p>
<p>In England, one report found there were almost <a href="https://inews.co.uk/news/women-menopause-appointments-2025-2275134?ico=in-line_link">7,000 women</a> on waiting lists for menopause treatment. They had to wait over <a href="https://inews.co.uk/news/women-menopause-appointments-2025-2275134?ico=in-line_link">seven months</a>, on average, for referral to a specialist clinic. </p>
<p>As some NHS trusts do not offer any specialist menopause support at all, women then have the option to travel large distances to access the service or to pay for <a href="https://inews.co.uk/news/hrt-shortage-gp-appointments-women-private-specialists-2151017?ico=in-line_link">private health care</a>. </p>
<p>To compensate for the educational gap, medical practitioners often resort to external courses for additional training, such as those offered by the <a href="https://thebms.org.uk/education/principles-practice-of-menopause-care/apply-for-the-ppmc-training-programme/">British Menopause Society</a>. However, these courses are costly in both time and money, which can be discouraging for the already overburdened and underpaid healthcare workers.</p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>Women themselves face obstacles in discussing menopause with their doctors. Until 2019, menopause was not included in the school sexual health or science curriculums, meaning women often know very little about the transition until they start experiencing it themselves. </p>
<p>Data from a <a href="https://journals.sagepub.com/doi/10.1177/20533691231166543">sample of post-menopausal women</a> found that 94% had never been taught about menopause at school and 49% felt uninformed about menopause before experiencing it. </p>
<h2>Improving menopause education</h2>
<p>Recognising the need for improving menopause education for both those experiencing it and those treating it, menopause was added to the <a href="https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education">UK’s national sex education curriculum in 2019</a>. </p>
<p>NHS England has also established the <a href="https://committees.parliament.uk/publications/33631/documents/183795/default/">Menopause Pathway Improvement Programme</a>. This is working to improve clinical medical care in England, reduce disparities in access to treatment and develop a comprehensive education and training package on menopause for healthcare professionals. </p>
<p><a href="https://committees.parliament.uk/publications/33631/documents/183795/default/">From 2024</a>, key topics related to women’s health, including menopause, will be included in mandatory assessments for UK medical students.</p>
<p>Despite these positive steps, there is still room for improvement. Menopause is already included in the general training for GPs, but only after medical school. But GPs have an incredibly broad medical education (as well as the shortest of the specialisms). </p>
<p>And there are signs they want more in-depth knowledge. In an <a href="https://journals.sagepub.com/doi/full/10.1177/20533691221106011">online survey</a> of GPs, 52% reported they felt they were not offered enough training to advise women with menopause symptoms. Some stated that they did not remember being taught the subject at all.</p>
<p>Despite this, the Royal College of General Practitioners <a href="https://www.rcgp.org.uk/getmedia/071f6a7a-f476-46bd-a996-be6eb8494b4c/RCGP-Brief_Menopause.pdf">recently argued against</a> recommendations to mandate menopause training, instead placing the responsibility on the individual GP to ensure their clinical knowledge of menopause remains up to date. </p>
<p>In recent years, menopause has gained significant media coverage through campaigns by companies, charities and public figures. This increased awareness has encouraged women to seek help from their GPs, but this has led to clinics becoming overwhelmed while still under-resourced.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1555581794648481793"}"></div></p>
<p>But this is a positive step, as it suggests women are feeling empowered to seek help for their menopause symptoms. As a further sign of progress, University College London has recently announced a new <a href="https://www.ucl.ac.uk/news/2023/aug/plans-uks-first-menopause-education-programme-launched-ucl-academics">National Menopause Education and Support Programme</a>. This will provide a course spread over several weeks to educate women on menopause and also provide them with peer support throughout the transition. </p>
<p>The next crucial step is to equip medical professionals with the knowledge and resources they need to effectively support women. By doing so, we can ensure women receive the care they need and deserve during this important life transition and improve overall wellbeing in later life.</p><img src="https://counter.theconversation.com/content/207450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Arnot has previously received funding from the ESRC and BBSRC. </span></em></p>Around 7,000 women were on waiting lists for menopause treatment in England earlier this year, one report found.Megan Arnot, Lecturer (Teaching) in Evolutionary Anthropology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083152023-09-07T15:18:16Z2023-09-07T15:18:16ZWhen IVF fails it can be devastating – so why do clinics offer so little in the way of support?<p>Four in every ten people who start IVF treatment in the UK end it without having their child, according to <a href="https://doi.org/10.1136/bmj.i5735">data</a> from the UK fertility regulator, the <a href="https://www.hfea.gov.uk/">Human Fertilisation and Embryology Authority</a>. </p>
<p>Fertility clinics’ websites are prone to promoting their success rates or enthusing about the <a href="https://www.sciencedirect.com/science/article/pii/S1472648320303928">latest technology</a> that will revolutionise treatment. But <a href="https://bmjopen.bmj.com/content/7/1/e012218">research has found</a> these websites often report on the clinic’s pregnancy or live birth rates without relevant information on how these figures were calculated, or how many patients were involved. </p>
<p>It has also been shown that some clinics <a href="https://bmjopen.bmj.com/content/6/11/e013940">make claims</a> about treatment benefits without including supporting evidence.</p>
<p>But what is less talked about is the effect that unsuccessful treatment has on patients.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>The reality of failed IVF</h2>
<p>Ending treatment unsuccessfully can be <a href="https://edition.cnn.com/2022/11/19/health/ivf-women-jennifer-aniston-wellness-cec/index.html">devastating for patients</a>, throwing them into deep sadness, grief and loss. Those who go through this experience lose their sense of purpose and struggle to make sense of a new reality that denies a so desired family and parenting role. </p>
<p>Patients talk about feeling isolated from the “fertile world” and alone in their grief, with its constant pain making it hard to be with friends who have children. Indeed, the end of unsuccessful treatment is such a challenging experience that it takes on average <a href="https://doi.org/10.1002/j.1556-6676.2001.tb01991.x">two years</a> for patients to come to terms with their loss, recover their sense of balance and renew their hope for the future. </p>
<p>Research shows that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">mental health and wellbeing are significantly impaired</a> during this process and that <a href="https://doi.org/10.1093/humrep/dew131">around one in ten people never fully recover</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543721/original/file-20230821-15-gf7wgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Going through a failed IVF cycle can be tough on couples.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/upset-black-couple-sitting-apart-at-home-5700169/">pexels/alex green</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Research has also found that <a href="https://academic.oup.com/humupd/article/23/3/322/2970305">many of these patients</a> that are unsuccessful in their treatments say they feel abandoned by their fertility clinics when they most need support – which can lead them to become angry and frustrated. Indeed, as it currently stands there aren’t any support interventions <a href="https://bmjopen.bmj.com/content/5/1/e006592.short">available to infertile patients</a>, that are tailored to support them when treatment ends unsuccessfully. </p>
<p>The lack of evidence-based support for parents in this position is so striking that it prompted me and my colleagues to develop <a href="https://myjourney.pt/">MyJourney</a>, a free self-guided app that provides step-by-step support to ease the acceptance of an unfulfilled wish for children. <a href="https://doi.org/10.1093/humrep/deac168">Our research shows</a> that using MyJourney is linked to improvements in wellbeing within ten weeks – and that these improvements seem to last for at least six months.</p>
<h2>Support and care</h2>
<p>I believe that clinics need to do more to forewarn patients of the reality of IVF failure. Not only would this mean people go into the process properly informed, but it would also offer patients the opportunity to discuss and prepare for grief and sadness if it does happen. </p>
<p>Fertility staff also need to give patients a realistic view of treatment that does not soften its well-known challenges. Patients want to know what to expect and how to prepare for it. They want to have the “bigger picture” view of what the treatment entails so they can make informed decisions. <a href="https://doi.org/10.1093/humrep/dead096">Patients agree</a> these are difficult conversations to have but the research shows that most think the pros outweigh the cons. </p>
<p>Essentially the fertility industry needs to provide the best care for those who take a chance on IVF. And all patients should be able to access support during and after treatment, irrespective of its outcome.</p><img src="https://counter.theconversation.com/content/208315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Gameiro works for Cardiff University. She reports consultancy fees from TMRW Life Sciences
and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International
and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.</span></em></p>IVF doesn’t always work, but clinics often don’t make that clear to patients.Sofia Gameiro, Reader at the School of Psychology, Cardiff University, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114182023-09-05T20:06:11Z2023-09-05T20:06:11ZHow much period blood is ‘normal’? And which sanitary product holds the most blood?<figure><img src="https://images.theconversation.com/files/544687/original/file-20230825-19-mnnz4r.jpg?ixlib=rb-1.1.0&rect=26%2C17%2C5881%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-hand-reusable-menstrual-disc-on-2331704445">Shutterstock</a></span></figcaption></figure><p>Heavy menstrual bleeding or heavy periods affect up to a <a href="https://www.safetyandquality.gov.au/sites/default/files/migrated/Heavy-Menstrual-Bleeding-Clinical-Care-Standard.pdf">quarter of women</a> and people who menstruate, and <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">can impact quality of life</a>. Women who have had heavy periods for a long time often consider this normal, or <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">something to be simply put up with</a>. </p>
<p>Diagnosing heavy periods has traditionally been based on the nature of bleeding. Women might describe bleeding through clothing, having to change pads and tampons every two hours or sooner, or passing clots larger than a 50 cent coin. Doctors consider a woman to have heavy periods if she <a href="https://www.ncbi.nlm.nih.gov/books/NBK279294/#:%7E:text=Doctors%20consider%20a%20woman%20to,fitness%20and%20other%20individual%20factors.">regularly loses more than 80 millilitres of blood</a> during one menstrual period. That’s four Australian tablespoons’ worth. Women diagnosed with heavy bleeding should follow up with their doctor to establish the cause of their bleeding and guide treatment. </p>
<p>But estimating blood loss and getting a sense of when it’s outside the normal range can be difficult. Recent research on how best to manage menstrual blood could help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">Heavy periods are common. What can you do, and when should you seek help?</a>
</strong>
</em>
</p>
<hr>
<h2>More period options than ever</h2>
<p>There are now a variety of menstrual products for women to choose from.</p>
<p>These include disposable pads and tampons, as well as reusable products such as menstrual cups and discs, washable pads and period underwear. There are multiple factors which influence choice of menstrual product, including comfort, cost, capacity, environmental benefits and <a href="https://www.healthdirect.gov.au/toxic-shock-syndrome">potential health risks</a>. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2468784721001987?via%3Dihub">2022 French survey</a> of over 1,100 women showed traditional sanitary protection was still the most widely used there (81% used disposable pads and 46% used tampons) but 16% of respondents were using alternative products. A <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02197-3">recent study in Victoria</a> indicated many young people are choosing reusable products, with environmental impacts an important motivator. </p>
<p>Another benefit of reusable <a href="https://www.healthline.com/health/menstrual-cup-dangers#cups-vs-pads-and-tampons">menstrual cups</a> and <a href="https://www.healthline.com/health/menstrual-disc">menstrual discs</a> is they can remain in the vagina for up to 12 hours. A menstrual cup sits in the vagina below the cervix and extends into the canal. A menstrual disc, on the other hand, fits back into the vaginal fornix, which is where your vaginal canal meets your cervix. Discs are usually wider and shallower than cups and <a href="https://pubmed.ncbi.nlm.nih.gov/36791417/">can be worn during sex</a>. There are now reusable and disposable options for menstrual discs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line diagrams of various menstrual products: pads, tampons, cups, discs" src="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=137&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=137&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=137&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=172&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=172&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544686/original/file-20230825-2922-u0mb8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=172&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/simple-minimalist-lineart-period-products-including-2193917377">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-anyone-have-a-pad-tv-is-finally-dismantling-the-period-taboo-122258">Does anyone have a pad? TV is finally dismantling the period taboo</a>
</strong>
</em>
</p>
<hr>
<h2>What holds the most blood?</h2>
<p>There has been very limited research into the maximum capacity of different menstrual products. Manufacturers can report collection capacity of their products using liquids such as water. </p>
<p>A <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">recent research study from the United States</a> aimed to more accurately measure the capacity of menstrual products in the laboratory using expired donated human blood, which is more similar to menstrual blood. </p>
<p>Some 21 different menstrual products were tested in the study. Menstrual discs showed the greatest capacity (61ml on average) and period underwear held the least (2ml on average). </p>
<p>Tampons, pads, and menstrual cups held similar amounts of blood (approximately 20–50mL). The authors noted it is difficult to accurately approximate capacity for patients with heavy menstrual bleeding due to “flooding” (high-velocity flow) and passing clots. </p>
<p>The comparison shows period underwear, despite its advertised capacity, may actually only absorb a small amount of blood and very slowly. Women with heavy periods tend to use period underwear as “back up” for another method. </p>
<h2>We need a standardised scale for menstrual bleeding</h2>
<p>Currently, the ways to determine whether someone is having heavy menstrual bleeding is through asking detailed questions and using the <a href="https://www.rch.org.au/uploadedFiles/Main/Content/rch_gynaecology/PBAC.pdf">Pictorial Blood Loss Assessment Chart</a>, which relates to the saturation of menstrual pads and tampons. </p>
<p>The overall impact of the heaviness of menstrual bleeding on a woman’s quality of life is also important. </p>
<p>Even with pads and tampons, there is significant variability in terms of capacity. The introduction of newer products potentially introduces more confusion, with both users and clinicians uncertain about the storage capacity of each category of product, and specific brands within these categories. </p>
<p>With heavy menstrual bleeding often <a href="https://pubmed.ncbi.nlm.nih.gov/33840528/">underdiagnosed and undertreated</a>, clinicians need to ask specifically about the menstrual products used and how they are used to better understand a person’s bleeding patterns. The fresh US research could help women and their doctors better assess the heaviness of their periods. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-painful-periods-normal-62290">Health Check: are painful periods normal?</a>
</strong>
</em>
</p>
<hr>
<h2>3 tips for managing heavy flow</h2>
<ul>
<li><p><strong>1. Experiment with period products.</strong> It may be good to try out different types of products (and even different products in the same category) to find the ones that suit you best. The advertised capacity of each product may not ring true with your own experience, due to the nature of your flow (particularly if it is heavy or “gushes”). </p></li>
<li><p><strong>2. Monitor the heaviness of your period.</strong> The capacity of different menstrual products varies widely. Menstrual discs have very high storage capacity in comparison to other products. That can actually lead to an underestimation of menstrual loss. Looking up the storage capacity of each product can help you work out whether you are having heavy periods or not, even though we know this may be based on liquids like water. This information can be found on the product website or the <a href="https://srh.bmj.com/content/early/2023/07/03/bmjsrh-2023-201895">new study</a>. </p></li>
<li><p><strong>3. When to seek medical advice.</strong> If you think you might be having heavy periods, feel tired or dizzy during your period, or you feel your periods are interfering with your life, talk to your GP or other healthcare professional. It can help to track the heaviness of your periods and how often you are changing your period product and to bring this record to your appointment. Your GP can <a href="https://theconversation.com/heavy-periods-are-common-what-can-you-do-and-when-should-you-seek-help-191511">talk to you about treatment</a> with medications (both hormonal and non-hormonal) and other management options.</p></li>
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<p class="fine-print"><em><span>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.</span></em></p>Working out how much blood you’re losing and getting a sense of when it’s outside the normal range can be difficult. Recent research on the capacity of different period products could help.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyBianca Cannon, GP and Lecturer at Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.