tag:theconversation.com,2011:/uk/topics/hormones-565/articlesHormones – The Conversation2024-03-18T17:08:07Ztag:theconversation.com,2011:article/2247742024-03-18T17:08:07Z2024-03-18T17:08:07ZWhat your hair can tell you about your health<figure><img src="https://images.theconversation.com/files/579862/original/file-20240305-20-96aic6.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4684%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genetics, hormones and age can all affect our hair growth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/damaged-hair-frustrated-asian-young-woman-2403657911">Kmpzzz/ Shutterstock</a></span></figcaption></figure><p>Hair speaks volumes. The way we cut, style and colour often acts as a representation of who we are.</p>
<p>But hair is more than just aesthetic. It also has many important functions – preventing heat loss from the skin for instance, or (in the case of our eyebrows) stopping sweat dripping into the eyes. </p>
<p>Hair can be a reflection of what’s going on inside our body, too. Many diseases can alter the quality and appearance of our hair. Paying attention to the way it looks can give us clues to the state of our health. </p>
<h2>The hair cycle</h2>
<p>Some of the tiniest organs in our bodies are the follicles which produce and nourish hairs. Hair can only grow where follicles exist. </p>
<p>Hair growth is a complex process. Each tiny follicle goes through different <a href="https://www.sciencedirect.com/science/article/abs/pii/S1064740618300270?via%3Dihub">cyclical stages</a>. The first is the stage of active hair growth (the “anogen” phase), before growth is arrested (the “catagen” phase). This then progresses to the stage when the hair is lost or shed from the follicle (the “telogen” phase). </p>
<p>Many factors – from our genetics to our hormones to our age – can affect these follicles and their growth.</p>
<h2>Excess hair growth</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK534854/#:%7E:text=Introduction-,Hypertrichosis%20is%20defined%20as%20excessive%20hair%20growth%20anywhere%20on%20the,%5D%5B2%5D%5B3%5D">Hypertrichosis</a> is a condition where hair grows in excess all over the body. In most cases, this is a reaction to starting a new medication, such as phenytoin, which is used to treat epilepsy. But it may also be caused by diseases, such as <a href="https://www.sciencedirect.com/science/article/pii/S0738081X23000329?via%3Dihub">anorexia</a> and HIV. </p>
<p>Some conditions also cause hair to grow in places where it shouldn’t. In newborn babies, tufts of hair near the base of the spine may indicate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657727/pdf/cureus-0015-00000047396.pdf">spina bifida occulta</a>. This occurs when the lower vertebrae of the spine haven’t formed properly, leaving the delicate spinal cord covered only by skin. </p>
<p>The hows and whys of these conditions and their ability to trigger hypertrichosis remain poorly understood.</p>
<p>Hirsutism is another condition where hair grows excessively, but in a typically male pattern – on the face, lips, chest and arms. This is driven by androgen hormones, namely testosterone, which in high levels promotes hair growth in these regions. This may be observed in <a href="https://pubmed.ncbi.nlm.nih.gov/27510481/">polycystic ovary syndrome</a>.</p>
<h2>Hair loss</h2>
<p>Hair may also start to fall out in abnormal amounts, making it thinner or absent in certain body regions. The medical term for hair loss is <a href="https://cks.nice.org.uk/topics/alopecia-areata/">alopecia</a> and may either be localised or widespread. <a href="https://www.pcds.org.uk/clinical-guidance/alopecia-an-overview">Causes of alopecia</a> are manifold and include fungal infections, iron-deficiency anaemia, low thyroid hormone levels and use of medications (including chemotherapy). </p>
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<img alt="A man with hair loss." src="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.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">Male pattern baldness begins in the mid-20s.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-man-hair-loss-problem-2335225091">ANDRANIK HAKOBYAN/ Shutterstock</a></span>
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<p>Age, gender and genetics are also to blame. <a href="https://cks.nice.org.uk/topics/male-pattern-hair-loss-male-androgenetic-alopecia/">Male pattern baldness</a>, occurs at the hairline and the crown of the head. It’s influenced by the hormone testosterone, which shortens the growth phase of hairs and makes them finer. Most men with male pattern baldness will begin to observe hair loss by the age of 20-25. </p>
<p><a href="https://cks.nice.org.uk/topics/female-pattern-hair-loss-female-androgenetic-alopecia/">Female pattern baldness</a>, on the other hand, usually affects the front hairline first and causes thinning rather than complete loss. The role of testosterone is more debatable in women, but a hormonal cause is implicated since thinning is more common around and after the menopause. </p>
<p>Hair loss may also arise as a result of hair pulling. Styling hair tightly can cause <a href="https://knowyourskin.britishskinfoundation.org.uk/condition/traction-alopecia/#:%7E:text=Traction%20Alopecia%20is%20a%20type,pulled%20repeatedly%20by%20tight%20hairstyles.">traction</a> on the follicle and loss of hair integrity. Some people may also pull or pluck their hairs out of habit. This is called <a href="https://www.nhs.uk/mental-health/conditions/trichotillomania/">trichotillomania</a>.</p>
<h2>Treating hair problems</h2>
<p>Helping hair to regrow could be as simple as treating the underlying condition causing it. Another treatment to consider is the medication <a href="https://pubmed.ncbi.nlm.nih.gov/31496654/">minoxidil</a> – the active ingredient of Rogaine. It was initially developed as a treatment for high blood pressure, but was observed to also promote hair growth. This may be through a direct effect on hair follicles, or by improving blood flow to the scalp. These uncertainties may explain why some patients see good improvement, and others not. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0190962221009014?via%3Dihub">Hair transplants</a> are also a possibility, relocating crops of hairs to bald patches. There are two ways of performing them – you can either relocate multiple small “punched-out” grafts, or a larger strip of skin. The grafts are taken from hairy skin on the patient’s own body – this is an example of an autograft.</p>
<p>Sometimes the presence of hair in visible areas is not desirable, and there are certain treatments available to stop excessive growth. Aside from traditional hair removal methods, the contraceptive pill and other medications that <a href="https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html">regulate hormonal influence</a> on hair (such as finasteride), can be considered in cases where a hormonal condition is the cause (such as PCOS). </p>
<h2>Test your own hair</h2>
<p>In order to get a better sense of your hair’s health you can perform a simple test at home yourself, known as a <a href="https://dermnetnz.org/cme/principles/examination-of-hair-and-scalp">hair pull</a>. </p>
<p>Select a group of between 30-50 hairs (a small clump) and run your fingers from the base of the hairs at the scalp, up to the ends. You don’t need to pull hard – gentle traction is all that’s needed to dislodge a shedding hair. Look to see how many you’ve pulled out. </p>
<p>It’s normally only one or two hairs that will come out with one pull – but this can vary between people. Greater than ten hairs and your scalp is likely to be shedding more hairs than normal. This could be suggestive of alopecia – though having a dermatologist perform a <a href="https://pubmed.ncbi.nlm.nih.gov/31479564">more detailed inspection</a> may help you know if your hair loss indicates a more serious problem.</p>
<p>Changes in your hair may not simply be a case of age or how you’ve been styling it. There are many patterns of hair growth and loss to be aware of. Take heed of any differences noticed by you, or your hairdresser.</p><img src="https://counter.theconversation.com/content/224774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt 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>Many diseases can alter the quality and appearance of your hair.Dan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2223092024-02-20T16:52:14Z2024-02-20T16:52:14ZSuicide risk is higher in certain phases of the menstrual cycle – here’s what we know about this link<figure><img src="https://images.theconversation.com/files/576484/original/file-20240219-26-u4dbob.jpg?ixlib=rb-1.1.0&rect=32%2C0%2C3566%2C2375&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The study found women had a higher risk of suicide when hormones are fluctuating</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ny-usa-2-may2022young-fitness-woman-2157077103">Krotnakro/ Shutterstock</a></span></figcaption></figure><p>Women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539867/">twice as likely</a> to attempt suicide than men. This difference <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576496/">appears at puberty</a>, suggesting the menstrual cycle may play a key role. </p>
<p>Although this link has been known for a long time, it remains a disappointingly under-researched area. But a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10082663/">2023 study</a> provided new insight into this link – finding that women may be more likely to die by suicide during certain phases of their menstrual cycle. </p>
<p>The researchers conducted their analysis by pooling data from five studies on suicide and the menstrual cycle. They were then able to identify the menstrual cycle phase of 425 women who died by suicide, ranging in age from 11 to 50.</p>
<p>They found that suicide was most common in the secretory phase of the cycle (accounting for approximately 45% of deaths), followed by the proliferative phase (29% of deaths). The least common phase for death by suicide was the menstrual phase (approximately 18% of deaths). </p>
<p>Researchers aren’t entirely sure why suicide risk is higher during certain phases of the menstrual cycle. While it’s likely due to the complex interplay of many factors, some evidence suggests hormone fluctuations and how sensitive a person is to these changes may be related.</p>
<h2>Hormone sensitivity</h2>
<p>The menstrual cycle is divided into three phases. Each corresponds to different levels of circulating hormones, in particular estradiol and progesterone. </p>
<p>In the menstrual phase (when a woman typically has her period), these hormones are consistently low and stable. This is followed by the proliferative phase (also known as the follicular phase), where estradiol peaks. Finally, in the secretory phase (also known as the luteal phase), estradiol falls sharply while progesterone rises. </p>
<p>This recent study suggests that women have a higher risk of suicide when hormones are fluctuating. Collectively, these phases accounted for almost 80% of deaths. </p>
<p>One possible explanation for this link could be that some women are more sensitive to changing hormone levels throughout their cycle. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844188/">One review found</a> that while some women have no response to these hormone changes, others experience changes in their mood and mental health that ranged from mild to severe. </p>
<p>For some, these changes negatively affected their daily lives, sleep and relationships, all of which have a cumulative effect on mental health when experienced every month.</p>
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<img alt="A person draws the hormonal changes throughout the menstrual cycle on a sheet of paper." src="https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576485/original/file-20240219-22-qsp1nj.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">Some women may be more sensitive to the hormone changes that take place throughout the menstrual cycle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-view-hand-drawn-female-menstrual-2052064121">Linaimages/ Shutterstock</a></span>
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<p>This link may also be explained by some mental health conditions which are known to worsen during certain phases of the menstrual cycle. </p>
<p><a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/">Premenstrual dysphoric disorder</a>, for example, is a severe mood disorder that affects one in 20 women. It causes debilitating psychological symptoms in the week or two before one’s period (the secretory phase), such as overwhelming anxiety or anger.</p>
<p>For women diagnosed with PMDD, 72% will have suicidal thoughts, half will self-harm and one in three will <a href="https://link.springer.com/article/10.1186/s12888-022-03851-0">attempt suicide</a>. Tragically, some women with PMDD do not survive.</p>
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Read more:
<a href="https://theconversation.com/premenstrual-dysphoric-disorder-the-frightening-psychological-condition-suffered-by-dixie-damelio-193235">Premenstrual dysphoric disorder: the frightening psychological condition suffered by Dixie D'Amelio</a>
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<p>The menstrual cycle has also been shown to have a negative affect on pre-existing psychiatric disorders, including bipolar disorder, depression and anxiety. This is known as <a href="https://iapmd.org/pmdd-v-pme">premenstrual exacerbation</a> (PME).</p>
<p>Some of these disorders come with increased suicide risk. PME may worsen symptoms during the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502143/">secretory and proliferative phases</a>.</p>
<p>The menstrual cycle has also been linked with perimenopausal depression. During perimenopause (the transitional period before menopause), the menstrual cycle begins to change, becoming less predictable until it eventually stops. </p>
<p>This is a high-risk phase for women’s mental health. In the <a href="https://www.statista.com/statistics/1114127/female-suicide-rate-in-the-us-by-age-group/#:%7E:text=The%20suicide%20rate%20among%20females,elderly%20women%2075%20and%20over.">UK</a> and <a href="https://www.statista.com/statistics/1114127/female-suicide-rate-in-the-us-by-age-group/#:%7E:text=The%20suicide%20rate%20among%20females,elderly%20women%2075%20and%20over.">US</a>, death by suicide in women is highest in those of perimenopausal age suggesting a link with hormones. </p>
<h2>Social and cultural factors</h2>
<p>The menstrual cycle is of course not the only factor involved when it comes to suicide risk. Other <a href="https://www1.racgp.org.au/ajgp/2023/july/placing-womens-mental-health-in-context">social and cultural issues</a> play an important role. </p>
<p>Socioeconomic factors appear to be linked to suicide risk, with 77% of <a href="https://www.who.int/teams/mental-health-and-substance-use/data-research/suicide-data">global suicides</a> occurring in low- and middle-income countries. And in some such countries, suicide accounts for approximately 70% of violent deaths among women. In Nepal, for example, suicide is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656007/">single leading cause of death</a> in reproductive age women.</p>
<p>Women are also more likely than men to experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632781">sexual violence and intimate partner violence</a> – and to experience these types of trauma at a younger age. Childhood sexual abuse is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240465/#:%7E:text=Several%20studies%20have%20indicated%20that,depression%20and%20anxiety%20in%20adulthood.&text=It%20has%20also%20been%20suggested,between%20childhood%20trauma%20and%20suicide.">strongest predictors</a> of suicidality in women. </p>
<p>This form of gender-based violence is a key reason more women than men are diagnosed with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632782/">post-traumatic stress disorder</a> (PTSD). </p>
<p>Women are also <a href="https://iris.who.int/bitstream/handle/10665/66539/WHO_MSD_MDP_00.1.pdf">more likely</a> to live in poverty, leave education early, have lower-paid jobs and a higher burden of caring responsibilities. These cumulatively impact women’s mental health and may contribute to suicide risk.</p>
<p>There is also the complex <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051505/">intersection of race and ethnicity</a>, with research showing black women have the highest risk of trauma and mental health disorders compared to any other group. Research from the US shows black women have the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0287141">highest risk</a> of suicide among women.</p>
<h2>Need for support</h2>
<p>While the 2023 study highlighted the link between the menstrual cycle and suicide, there are some limitations to its design. </p>
<p>The review only included data from five studies, the majority of which were conducted in India. As such, more research will be needed to understand whether the picture is similar in other parts of the world, and to fully understand all the factors contributing to greater suicide risk during certain phases of the menstrual cycle.</p>
<p>But it isn’t the first study to uncover a link between menstrual cycle and increased suicide risk, showing the clear need for greater support in order to prevent harm. </p>
<p>While the past few years have seen more being done to <a href="https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england">address women’s health issues</a>, many questions still have not been fully answered. These include why women are more likely to die by suicide during certain phases of their menstrual cycle, what other social and cultural factors put women at greater risk of suicide and how can health professionals better assess those who may be most at risk.</p>
<hr>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/222309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynsay Matthews receives funding from the Royal Society of Edinburgh. </span></em></p>The study found women were at the greatest risk of suicide during the secretory and proliferative phases of their menstrual cycle.Lynsay Matthews, Lecturer in Public Health, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2219372024-01-29T17:28:03Z2024-01-29T17:28:03ZYour skin is a mirror of your health – here’s what yours might be saying<figure><img src="https://images.theconversation.com/files/571942/original/file-20240129-25-1m0rxc.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5168%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">_Acanthosis nigricans_ can cause skin to become thickened and velveteen to the touch.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/finger-girl-point-her-elbow-because-2124368729">TuktaBaby/ Shutterstock</a></span></figcaption></figure><p><a href="https://pubmed.ncbi.nlm.nih.gov/12095893/">Skin accounts for around 15% of our body mass</a>. It is the largest and most visible organ in the human body.</p>
<p>Yet many of the skin’s functions are often overlooked. It’s a sunscreen, a shield from germs, a reservoir of <a href="https://pubmed.ncbi.nlm.nih.gov/28994020/">vitamin D</a> and a means of tightly regulating our body temperature.</p>
<p>Being the most visible of our organs, the skin also offers us a view into the body tissues that it protects. So don’t think of your skin merely aesthetically – think of it as a reflection of your health. Disorders of the gut, blood, hormones and even the heart might first be seen on the skin in the form of a rash. </p>
<p>Here are a few to look out for.</p>
<h2>Bullseye</h2>
<p>Ticks are pesky creatures that no one will want to return home from a country walk with. </p>
<p>But while the vast majority of tick bites <a href="https://pubmed.ncbi.nlm.nih.gov/36116831/">won’t make you ill</a>, there is one rash that should prompt a visit to your doctor if you spot it.</p>
<p>Erythema migrans, a rash named for its ability to rapidly expand across the skin, is a hallmark of <a href="https://www.bmj.com/content/369/bmj.m1041.long">Lyme disease</a>, a potentially severe bacterial illness. This rash forms a classic target pattern, like a bullseye on a dartboard. </p>
<p>Be vigilant for a few weeks after being bitten to check this rash doesn’t make an appearance – especially if you noticed a red lump that wasn’t there before or if you had to remove a tick from your skin. You should also keep an eye out for other associated symptoms of Lyme disease – such as swinging temperatures, muscle and joint pains and headache.</p>
<p>The condition is treated with antibiotics, which can prevent long-term complications, including chronic fatigue symptoms. </p>
<h2>Purpura</h2>
<p>Some rashes are given a <a href="https://linkinghub.elsevier.com/retrieve/pii/S1538-7836(22)01880-3">colourful namesake</a> – purpura is one such example. This rash’s name is derived from a mollusc which was used to make purple dye.</p>
<p>Purpura refers to a rash of small purple or red dots. The cause is pooling of blood into a deeper layer of the skin (dermis). When pressed with a finger – or even better, the side of a glass – it refuses to blanch away.</p>
<p>Purpura signals an issue with either the walls of the tiny blood vessels that feed the skin or the blood within them. This might be from a deficiency in platelets, the tiny cell fragments that allow blood to clot – perhaps from bone marrow failure, or an autoimmune condition where the body turns on itself and attacks its own cells.</p>
<p>At worst, purpura may signal the life-threatening condition <a href="https://www.magonlinelibrary.com/doi/full/10.12968/hmed.2017.78.8.468">septicaemia</a>, where an infection has spread into the bloodstream – perhaps from the lungs, kidneys or even from the skin itself. </p>
<h2>Skin spiders</h2>
<p>Skin rashes can also take on <a href="https://pubmed.ncbi.nlm.nih.gov/32513406/">recognisable shapes</a>.</p>
<p>Spider naevi represent an issue within skin arterioles (small arteries which supply the skin with blood). Arterioles open and close to control the loss of heat from the body’s surface. But sometimes they can get stuck open – and a spider-like pattern will appear. </p>
<figure class="align-center ">
<img alt="A close-up of the red spider-like mark caused by _Spider naevus_." src="https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571945/original/file-20240129-17-8p0ov.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">This spider-like rash indicates issues with the arterioles.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-on-skin-girls-face-visible-1944367762">Evgeniya Sheydt/ Shutterstock</a></span>
</figcaption>
</figure>
<p>The open arteriole is the spider’s body, and the even tinier capillaries fanning out in all directions are the thready legs. Crush the body under a fingertip and the whole thing disappears, as your touch temporarily stops the blood flow. </p>
<p>Often, these are benign and not associated with any specific condition – especially if you only have one or two. However, more than three suggest higher circulating levels of the <a href="https://dermnetnz.org/topics/spider-telangiectasis">hormone oestrogen</a>, often due to liver disease or from the hormonal changes seen in pregnancy. Treat the underlying cause, and the spiders often vanish with time – though they may persist or reappear later. </p>
<h2>Black velvet</h2>
<p>Changes to the folds of your skin (usually around the armpits or neck) – especially if it becomes thickened and velveteen to the touch – may suggest a condition known as <a href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.13544">acanthosis nigricans</a>. This “black velvet” skin appearance is more commonly seen in darker skins. </p>
<p>Usually, the condition is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/29241752/">disorders of the metabolism</a> – namely type 2 diabetes and polycystic ovary syndrome. If either of these conditions are successfully treated, the rash may fade. In rare cases, it can also be a sign of <a href="https://www.hkmj.org/abstracts/v29n4/355.htm">stomach cancer</a>, which should be considered in patients with few or none of the key signs of metabolic disease (obesity and high blood pressure). </p>
<h2>Butterfly rashes</h2>
<p>Even disorders of the heart can be visible on the skin.</p>
<p>Cardiac valves have the important role of correctly directing the journey of blood through the heart and preventing backflow. The valve between the chambers on the left side of the heart (the mitral valve – so called because of its resemblance to a bishop’s hat, or mitre) can sometimes become narrowed, causing the heart’s function to deteriorate. The body’s natural response is to preserve core blood volume, shutting off flow towards the skin.</p>
<p>The net effect can produce a purple-red rash, high across the cheeks and the bridge of the nose, like the outstretched wings of a butterfly. We call this <a href="https://journals.sagepub.com/doi/10.1177/2050313X231200965?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">mitral facies</a> which, depending on the extent of damage to the heart and great vessels, may persist despite treatment. </p>
<p>It’s important to pay heed to your skin. It’s constantly talking to you, and any changes in its texture, colour or if new marks or patterns appear, may indicate something is going on beneath the surface.</p><img src="https://counter.theconversation.com/content/221937/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt 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>Skin is the largest and most visible organ in the human body – and can provide many clues about what’s going on underneath it.Dan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193292024-01-12T00:16:53Z2024-01-12T00:16:53ZFrom straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair<figure><img src="https://images.theconversation.com/files/567011/original/file-20231221-27-ytfbxc.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&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/back-view-young-beautiful-woman-white-1489934231">Orawan Pattarawimonchai/Shutterstock</a></span></figcaption></figure><p>Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36631178/">Many different genes</a> determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.</p>
<p>So, what can cause hair to become curlier, thicker, thinner or grey?</p>
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Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
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<h2>Curly or straight? How hair follicle shape plays a role</h2>
<p>Hair is made of <a href="https://my.clevelandclinic.org/health/body/23204-keratin">keratin</a>, a strong and insoluble protein. Each hair strand grows from its own <a href="https://www.ncbi.nlm.nih.gov/books/NBK470321/">hair follicle</a> that extends deep into the skin. </p>
<p>Curly hair forms due to asymmetry of both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894537/">hair follicle and the keratin</a> in the hair.</p>
<p>Follicles that produce <a href="https://www.medicalnewstoday.com/articles/318524">curly hair</a> are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.</p>
<p>The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow. </p>
<p>Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram shows the hair follicle shape of straight, curly and coiled hair." src="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.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">Each hair strand grows from its own hair follicle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/diagram-hair-follicle-shape-vector-illustration-2248429145">Mosterpiece/Shutterstock</a></span>
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</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-dandruff-how-do-i-get-rid-of-it-why-does-it-keep-coming-back-201082">What is dandruff? How do I get rid of it? Why does it keep coming back?</a>
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</em>
</p>
<hr>
<h2>Life changes, hair changes</h2>
<p>Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.</p>
<p>Each hair follicle contains stem cells, which multiply and <a href="https://www.frontiersin.org/articles/10.3389/fcell.2022.899095/full">grow into a hair strand</a>.</p>
<p>Head hairs spend most of their time in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905671/">the growth phase</a>, which can last for several years. This is why head hair can grow so long. </p>
<p>Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it <a href="https://www.healthline.com/health/stages-of-hair-growth">naturally falls out</a>.</p>
<p>The hair follicle <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13347">remains in the skin</a> and the stems cells grow a new hair to repeat the cycle.</p>
<p>Each hair on the scalp is replaced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/#b3">every three to five years</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with curly hair works on her computer." src="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.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">Each hair on the scalp is replaced every three to five years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-businesswoman-office-beautiful-woman-listening-1702284601">Just Life/Shutterstock</a></span>
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<h2>Hormone changes during and after pregnancy alter the usual hair cycle</h2>
<p>Many women notice their hair is <a href="https://www.medicalnewstoday.com/articles/pregnancy-hair">thicker during pregnancy</a>.</p>
<p>During pregnancy, high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908443/">oestrogen, progesterone and prolactin</a> prolong the resting phase of the hair cycle. This means the hair <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">stays in the hair follicle for longer</a>, with less hair loss. </p>
<p>A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way. </p>
<h2>Hair can change around puberty, pregnancy or after chemotherapy</h2>
<p>This is related to the genetics of hair shape, which is an example of <a href="https://www.biologyonline.com/dictionary/incomplete-dominance">incomplete dominance</a>. </p>
<p>Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair. </p>
<p>Hormonal changes that occur around <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-019-0780-4">puberty</a> and <a href="https://www.mdpi.com/1422-0067/23/20/12698">pregnancy</a> can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.</p>
<p>Researchers have identified that activating specific genes can change hair in pigs <a href="https://www.frontiersin.org/articles/10.3389/fgene.2023.1184015/full">from straight to curly</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759815/">Chemotherapy</a> has very visible effects on hair. Chemotherapy kills rapidly dividing cells, <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2628766">including hair follicles</a>, which causes hair loss. Chemotherapy can also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1988866/">genetic effects</a> that influence hair follicle shape. This can cause hair to <a href="https://www.medicalnewstoday.com/articles/chemo-curls">regrow with a different shape</a> for the first few cycles of hair regrowth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with wavy hair looks in a mirror" src="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.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">Your hair can change at different stages of your life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-redhaired-girl-bathroom-looks-mirror-2139652407">Igor Ivakhno/Shutterstock</a></span>
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</figure>
<h2>Hormonal changes as we age also affect our hair</h2>
<p>Throughout life, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">thyroid hormones</a> are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36578854/">Oestrogen and androgens</a> also regulate hair growth and loss, particularly as we age. </p>
<p>Balding in males is due to <a href="https://theconversation.com/starting-to-thin-out-hair-loss-doesnt-have-to-lead-to-baldness-34984">higher levels of androgens</a>. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269836/">male pattern baldness</a>. </p>
<p>Some women experience <a href="https://theconversation.com/health-check-why-does-womens-hair-thin-out-39126">female pattern hair loss</a>. This is caused by a combination of genetic factors plus lower levels of <a href="https://www.mdpi.com/2077-0383/12/3/893">oestrogen and higher androgens</a> after menopause. The hair follicles become smaller and smaller until they no longer produce hairs. </p>
<p>Reduced function of the cells that produce <a href="https://www.health.com/mind-body/what-going-gray-early-can-tell-you-about-your-health">melanin</a> (the pigment that gives our hair colour) is what causes greying.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-why-dont-burns-bleed-130792">Curious Kids: why don't burns bleed?</a>
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<img src="https://counter.theconversation.com/content/219329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theresa Larkin 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>Changes around puberty and pregnancy can affect the function of genes influencing hair shape. And chemotherapy can cause hair to regrow in a different shape for the first few cycles of hair regrowth.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2188742023-12-18T13:20:32Z2023-12-18T13:20:32ZStudents could get more sleep and learn better if school started a little later<figure><img src="https://images.theconversation.com/files/564471/original/file-20231208-27-k39utf.jpg?ixlib=rb-1.1.0&rect=23%2C11%2C3916%2C2280&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About 58% of middle schoolers and 73% of high schoolers do not get enough sleep.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-is-tired-and-sleeping-at-the-desk-in-classroom-royalty-free-image/1503343198?phrase=students+sleeping+in+class">JackF via iStock / Getty Images Plus</a></span></figcaption></figure><p>Nearly three-quarters of high school students do not get enough sleep on school nights, according to the <a href="https://www.cdc.gov/healthyschools/features/students-sleep.htm">Centers for Disease Control and Prevention</a>.</p>
<p>The National Sleep Foundation recommends that teens sleep for <a href="https://doi.org/10.1016/j.sleh.2014.12.010">eight to 10 hours per night</a>. But various factors hinder this, including early school start times and <a href="https://doi.org/10.1093/sleep/16.3.258">shifts in adolescents’ circadian rhythms</a> – the biological internal clock that regulates the sleep-wake cycle and repeats roughly every 24 hours. <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">Healthy sleep is crucial</a> for teens’ physical, cognitive and emotional development. When teens don’t get enough sleep, it can have lifelong impacts. They range from <a href="https://doi.org/10.1111/j.1365-2869.2011.00934.x">poor mental health</a> to <a href="https://doi.org/10.5664/jcsm.10156">lower attendance and graduation rates</a>.</p>
<p>As a neurologist <a href="https://scholar.google.com/citations?user=sTqquL0AAAAJ&hl=en">specializing in sleep disorders</a>, I have studied the profound importance of sleep in optimizing the body and mind. I believe insufficient sleep among adolescents is a public health crisis. This is why I reached out to my local state representative in Pennsylvania, <a href="https://www.legis.state.pa.us/cfdocs/legis/home/member_information/house_bio.cfm?id=1951">Rep. Jill Cooper</a>, a member of the House Education Committee, in October 2023 and pushed for legislative change. The resulting <a href="https://legiscan.com/PA/bill/HB1848/2023">proposed bill</a> would mandate that middle and high schools start no earlier than 8:15 a.m. by the 2026-27 school year.</p>
<p>While parents, educators and school administrators cannot alter biology, they can change school start times to allow students to obtain sufficient sleep for academic success and physical and mental well-being. In fact, the American Academy of Pediatrics <a href="https://doi.org/10.1542/peds.2014-1697">recommends pushing back school start times</a> to 8:30 a.m. or later.</p>
<p>Around the world, <a href="https://worldpopulationreview.com/country-rankings/average-school-day-length-by-country">school start times vary considerably</a>, from 7 a.m. in Brazil to 9 a.m. in Finland. While I’m not aware of any global dataset or research on the relationship between school start times and academic performance, Finland was ranked No. 2 on the list of <a href="https://worldpopulationreview.com/country-rankings/education-rankings-by-country">best educational systems</a> in the Global Citizens for Human Rights report in 2020. Canada, where the average school day begins at 8:30 a.m., was ranked No. 4.</p>
<h2>Sleep and the teenage brain</h2>
<p>Parents may notice that their kids, who were once early birds, start to sleep later and later as they hit their teen years. This is not just due to typical teen behavior like playing video games late at night, but rather it’s a <a href="https://doi.org/10.1093/sleep/16.3.258">biological response</a>.</p>
<p>During adolescence, changes in hormone levels, along with physical and brain maturation, lead to natural shifts in the circadian rhythm. The body tends to delay the release of melatonin, the hormone responsible for bringing on drowsiness at night. </p>
<p>Consequently, teens often find it <a href="https://doi.org/10.1016/j.pcl.2011.03.003">challenging to fall asleep early</a>, leading to a later bedtime. This delayed circadian rhythm also results in a preference for waking up later in the morning. These changes clash with societal and cultural expectations such as early school start times, often contributing to sleep deprivation among teenagers.</p>
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<iframe src="https://player.vimeo.com/video/694426344" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Changes in hormones and the circadian rhythm make it difficult for teens to fall asleep and wake up early. Healthy Hours via Vimeo</span></figcaption>
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<p>More than 80% of public middle and high schools across the United States <a href="https://nces.ed.gov/pubs2020/2020006/index.asp">start before 8:30 a.m.</a>, with 42% starting before 8 and 10% before 7:30. Consequently, bus pickup for some children can be as early as <a href="https://www.orlandosentinel.com/2015/04/18/5-am-bus-rides-630-walks-to-school-all-too-early/">5 a.m. in some districts</a>. What follow are four negative outcomes associated with early school start times.</p>
<h2>Hindered academic success</h2>
<p>Numerous studies have linked early school start times to poorer performance on <a href="https://doi.org/10.1542/peds.2014-1697">academic tests</a>. </p>
<p>One study looked at <a href="https://doi.org/10.5664/jcsm.10156">school start times, graduation rates and attendance rates</a> for 30,000 students in 29 high schools across seven states. It found a significant improvement in attendance rates, from 90% to 93%, and graduation rates, from 80% to 90%, four years after delaying school start times to 8:30.</p>
<p>Sleep deprivation has been shown to worsen <a href="https://doi.org/10.1093/sleep/zsab051">memory, learning ability, attention span</a>, <a href="https://doi.org/10.1016/B978-0-444-53702-7.00007-5">creativity</a>, <a href="https://doi.org/10.1177/019263650208663302">school attendance</a> and <a href="https://doi.org/10.1001/archpediatrics.2010.96">first-period tardiness</a> – a perfect storm for poor academic performance. </p>
<h2>Poorer mental health</h2>
<p>A recent <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">advisory from the U.S. surgeon general</a> raised the alarm on the harmful impacts of social media on youth mental health. Researchers have unearthed mounds of evidence on the negative effects, including <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">poor body image</a>. In these discussions, however, a simple yet powerful solution for improving mental well-being is often overlooked – the profound impact of sleep. </p>
<p>During REM sleep – or the dream state – our memories consolidate and we process emotions. Insufficient sleep increases the risk of <a href="https://doi.org/10.1111/j.1365-2869.2011.00934.x">depression</a>, <a href="https://doi.org/10.1542/peds.2014-1696">anxiety</a> and <a href="https://doi.org/10.1093/sleep/27.7.1351">suicide</a> among adolescents. One study showed that for every extra hour of sleep among adolescents, their <a href="https://doi.org/10.1016/j.smrv.2018.07.003">risk of suicide decreased</a> by 11%. </p>
<h2>Impaired physical health and social behavior</h2>
<p>Sleep is fundamental for physical well-being. For both children and adults, it plays a key role in essential bodily functions. During slow-wave sleep – or deep sleep – our bodies restore themselves: Our <a href="https://doi.org/10.1007/s00424-011-1044-0">immune system strengthens</a> to keep us healthy. And our waste-clearing glymphatic system <a href="https://doi.org/10.3389/fnins.2021.639140">eradicates neurotoxic proteins</a>, which are linked to diseases like Alzheimer’s. </p>
<p>Sleep deprivation is associated with higher rates of <a href="https://doi.org/10.1155/2012/476914">obesity</a>, <a href="https://doi.org/10.5664/jcsm.6288">diabetes, cardiovascular problems, chronic health conditions</a>, <a href="https://doi.org/10.1016/j.sleep.2019.03.008">physical injuries</a> and weakened immune function. Sleep-deprived students are more likely to fall asleep when sedentary, such as when driving a car. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603528/">Motor vehicle accidents</a> related to driving while drowsy are especially prevalent among teen drivers.</p>
<p>Sleep-deprived students are also more likely to demonstrate aggression, struggle with social communication and engage in risk-taking behaviors. One study found that the amount of sleep that high school students get is directly related to their <a href="https://doi.org/10.1001/jamapediatrics.2018.2777">engagement in unsafe behaviors</a>, such as substance abuse, risky driving, aggressive behavior and tendency toward self-harm. </p>
<h2>An economic cost</h2>
<p>The economic ramifications of this crisis may not be immediately obvious, but they are undeniable. Contrary to <a href="https://lacomadre.org/2019/10/beyond-students-late-school-start-times-could-impact-parents-and-transportation-budgets/">concerns that delayed school start times might increase transportation costs</a> by changing bus schedules, a 2017 study conducted by the nonprofit RAND Corp. found that the economic benefits <a href="https://doi.org/10.7249/RR2109">far outweigh the expenses</a>. </p>
<p>The study showed that a universal shift to 8:30 a.m. school start times would result in an $8.6 billion gain in the U.S. economy over two years. Investing in delayed school start times, therefore, isn’t a drain on resources. Instead, it contributes to a healthier future for generations to come.</p><img src="https://counter.theconversation.com/content/218874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanna Fong-Isariyawongse 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>Most teens aren’t getting enough sleep, leading to poorer academic performance. Early school start times combined with natural changes in hormones and the circadian rhythm could be to blame.Joanna Fong-Isariyawongse, Associate Professor of Neurology, University of PittsburghLicensed 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">
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<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>
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<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/2158082023-12-10T19:07:34Z2023-12-10T19:07:34ZI’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?<p>Benjamin Franklin, one of the founding fathers of the United States, famously said nothing is certain except death and taxes. But I think we can include “you’ll feel hungry when you’re trying to lose weight” as another certainty. </p>
<p>The reason is basic biology. So how does this work – and what can you do about it?</p>
<h2>Hormones control our feelings of hunger</h2>
<p>Several hormones play an essential role in regulating our feelings of hunger and fullness. The most important are ghrelin – often called the hunger hormone – and leptin.</p>
<p>When we’re hungry, <a href="https://pubmed.ncbi.nlm.nih.gov/11739476/">ghrelin</a> is released by our stomach, lighting up a part of our brain called the hypothalamus to tell us to eat. </p>
<p>When it’s time to stop eating, hormones, including <a href="https://pubmed.ncbi.nlm.nih.gov/8717038/">leptin</a>, are released from different organs, such as our gut and fat tissue, to signal to the brain that we’re full.</p>
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Read more:
<a href="https://theconversation.com/chemical-messengers-how-hormones-make-us-feel-hungry-and-full-35545">Chemical messengers: how hormones make us feel hungry and full</a>
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<h2>Dieting disrupts the process</h2>
<p>But when we change our diet and start losing weight, we disrupt how these <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766925/">appetite hormones function</a>. </p>
<p>This triggers a process that stems from our hunter-gatherer ancestors. Their bodies developed this mechanism as a survival response to adapt to periods of deprivation and protect against starvation. </p>
<p>The levels of hormones <a href="https://pubmed.ncbi.nlm.nih.gov/23126426/">managing our hunger increase</a>, making us feel hungrier to tell us to eat more, while the ones responsible for signalling we’re full decrease their levels, intensifying our feelings of hunger.</p>
<p>We end up increasing our calorie consumption so we eat more to regain the weight we lost. </p>
<p>But worse, even after the kilos creep back on, <a href="https://pubmed.ncbi.nlm.nih.gov/22029981/">our appetite hormones don’t restore</a> to their normal levels – they keep telling us to eat more so we put on a little extra fat. This is our body’s way of preparing for the next bout of starvation we will impose through dieting. </p>
<p>Fortunately, there are things we can do to manage our appetite, including:</p>
<h2>1. Eating a large, healthy breakfast every day</h2>
<p>One of the easiest ways to manage our feelings of hunger throughout the day is to eat most of our food earlier in the day and taper our meal sizes so dinner is the smallest meal.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> shows a low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day. </p>
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<img alt="Man spreads avocado" src="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.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">Prioritise breakfast over dinner.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soft-focus-shot-man-having-delicious-759322450">Shutterstock</a></span>
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<p><a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)00344-8">Another study</a> found the same effect. Participants went on a calorie-controlled diet for two months, where they ate 45% of their calories for breakfast, 35% at lunch and 20% at dinner for the first month, before switching to eat their largest meal in the evening and their smallest in the morning. Eating the largest meal at breakfast resulted in decreased hunger throughout the day.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> also shows we burn the calories from a meal 2.5-times more efficiently in the morning than the evening. So emphasising breakfast over dinner is good not just for hunger control, but also weight management.</p>
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Read more:
<a href="https://theconversation.com/should-we-eat-breakfast-like-a-king-lunch-like-a-prince-and-dinner-like-a-pauper-86840">Should we eat breakfast like a king, lunch like a prince, and dinner like a pauper?</a>
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<h2>2. Prioritising protein</h2>
<p>Protein helps contain feelings of hunger. This is because protein-rich foods such as lean meats, tofu and beans suppress the appetite-stimulating ghrelin and stimulate another hormone called <a href="https://www.sciencedirect.com/science/article/pii/S1550413106002713">peptide YY</a> that makes you feel full. </p>
<p>And just as eating a breakfast is vital to managing our hunger, what we eat is important too, with <a href="https://pubmed.ncbi.nlm.nih.gov/24703415/">research</a> confirming a breakfast containing protein-rich foods, such as eggs, will leave us feeling fuller for longer. </p>
<p>But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado.</p>
<h2>3. Filling up with nuts and foods high in good fats and fibre</h2>
<p>Nuts often get a bad rap – thanks to the misconception they cause weight gain – but nuts can help us manage our hunger and weight. The filling fibre and good fats found in nuts take longer to digest, meaning our hunger is satisfied for longer. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/12791613/">Studies</a> suggest you can include up to 68 grams per day of nuts without affecting your weight. </p>
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Read more:
<a href="https://theconversation.com/health-check-will-eating-nuts-make-you-gain-weight-108491">Health check: will eating nuts make you gain weight?</a>
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<p>Avocados are also high in fibre and heart-healthy monounsaturated fats, making them another excellent food for managing feelings of fullness. This is backed by a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567160/">study</a> confirming participants who ate a breakfast incorporating avocado felt more satisfied and less hungry than participants who ate a meal containing the same calories but with lower fat and fibre content. </p>
<p>Similarly, eating foods that are high in soluble fibre – such as <a href="https://pubmed.ncbi.nlm.nih.gov/24820437/">beans</a> and vegetables – make us feel fuller. This type of fibre attracts water from our gut, forming a gel that slows digestion. </p>
<figure class="align-center ">
<img alt="Couple cook together" src="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.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">Fibre helps us feel fuller for longer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-man-and-a-woman-preparing-food-in-a-kitchen-hQocGyy0unQ">Sweet Life/Unsplash</a></span>
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<h2>4. Eating mindfully</h2>
<p>When we take time to really be aware of and enjoy the food we’re eating, we slow down and eat far less. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/28718396/">review</a> of 68 studies found eating mindfully helps us better recognise feelings of fullness. Mindful eating provides our brain enough time to recognise and adapt to the signals from our stomach telling us we’re full.</p>
<p>Slow down your food consumption by sitting at the dinner table and use smaller utensils to reduce the volume of food you eat with each mouthful.</p>
<h2>5. Getting enough sleep</h2>
<p>Sleep deprivation disturbs our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1389945708700133">appetite hormones</a>, increasing our feelings of hunger and <a href="https://www.nature.com/articles/ncomms3259">triggering cravings</a>. So aim to get at least seven hours of uninterrupted sleep a night.</p>
<p>Try switching off your devices <a href="https://journals.sagepub.com/doi/full/10.1177/1477153515584979">two hours before bed</a> to boost your body’s secretion of sleep-inducing hormones like melatonin.</p>
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Read more:
<a href="https://theconversation.com/why-our-brain-needs-sleep-and-what-happens-if-we-dont-get-enough-of-it-83145">Why our brain needs sleep, and what happens if we don’t get enough of it</a>
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<h2>6. Managing stress</h2>
<p>Stress increases our <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">body’s production of cortisol</a> and triggers food cravings.</p>
<p>So take time out when you need it and set aside time for stress-relieving activities. This can be as simple as getting outdoors. A <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00722/full">2019 study</a> found sitting or walking outdoors at least three times a week could reduce cortisol levels by 21%. </p>
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<img alt="Person walks in house, next to grey dog" src="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&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">Take time out to reduce your stress levels.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gray-dog-looking-at-the-person-qqpfqFwAyDQ">Evieanna Santiago/Unsplash</a></span>
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<h2>7. Avoiding depriving ourselves</h2>
<p>When we change our diet to lose weight or eat healthier, we typically restrict certain foods or food groups. </p>
<p>However, this <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">heightens activity</a> in our mesocorticolimbic circuit – the reward system part of the brain – often resulting in us craving the foods we’re trying to avoid. Foods that give us pleasure release feel-good chemicals called endorphins and learning chemicals called dopamine, which enable us to remember – and give in to – that feel-good response.</p>
<p>When we change our diet, activity in our hypothalamus – the clever part of the brain that regulates emotions and food intake – <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">also reduces</a>, decreasing our control and judgement. It often triggers a psychological response dubbed the “what-the-hell effect”, when we indulge in something we think we shouldn’t feel guilty about and then go back for even more.</p>
<p>Don’t completely cut out your favourite foods when you go on a diet or deprive yourself if you’re hungry. It will take the pleasure out of eating and eventually you’ll give into your cravings. </p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/215808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>When we change our diet, we disrupt our appetite hormones. Here’s how it works – and how small changes to our diet can help us feel fuller for longer.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2131402023-10-15T12:27:54Z2023-10-15T12:27:54ZHow climate change-induced stress is altering fish hormones — with huge repercussions for reproduction<p>In <a href="https://doi.org/10.1126/science.213.4507.577">1981, scientists discovered that female fish exposed to high temperatures developed testes instead of ovaries</a>. Since then, over 1,100 studies on different animal species, including 400 on freshwater fish, have found similar results.</p>
<p>This raises several questions.</p>
<p>Why does this happen? How can this be explained, and does it harm long-term fish populations? Our research has shown that a key factor in explaining this is the over-production of stress hormones as a result of higher temperatures.</p>
<h2>No time to adapt</h2>
<p>Fish reproductive organs are highly adaptable to environmental changes as, unlike mammals, <a href="https://doi.org/10.1016/S0044-8486(02)00057-1">they have simple structures</a>. Remarkably, even slight changes in water conditions can directly and significantly <a href="https://doi.org/10.1038/s41586-019-1132-4">impact fish metabolism and physiology</a>.</p>
<p>Fish use this to their advantage by using environmental cues to <a href="https://doi.org/10.1007/s00018-020-03532-9">align their reproductive success with seasonal conditions</a>. For example, several fish species, like the <a href="https://www.alberta.ca/lake-sturgeon">yellow sturgeon, breed in the springtime cued by the warmer water temperatures</a>.</p>
<p>However, sudden environmental changes brought about by climate change are drastically affecting fish populations and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880135/pdf/rstb20100055.pdf">pushing some of them to move to more suitable breeding habitats</a>.</p>
<h2>Temperature can change female to male fish</h2>
<p>Studying how female fish become male (or are masculinized) through temperature change has led to a significant breakthrough. When fish are exposed to temperatures outside their normal range, they become stressed and experience a high level of the <a href="https://my.clevelandclinic.org/health/articles/22187-cortisol">stress hormone called cortisol</a>. This is the case for several fish species, such as the <a href="https://doi.org/10.1111/j.1095-8649.2010.02780.x">Argentinian silverside</a>, <a href="https://doi.org/10.1159/000100035">medaka</a> and <a href="https://doi.org/10.1073/pnas.1609411114">zebrafish</a>. </p>
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Read more:
<a href="https://theconversation.com/if-we-protect-mangroves-we-protect-our-fisheries-our-towns-and-ourselves-214390">If we protect mangroves, we protect our fisheries, our towns and ourselves</a>
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<p>Interestingly, the same enzyme that generates cortisol is also in charge of producing the most potent male hormone in fish called <a href="https://doi.org/10.1210/jc.2016-2311">11-ketotestosterone</a>. The role of this male hormone is to trigger the development of male sexual characteristics in fish. </p>
<p>If fish experience stress — i.e., an increase in cortisol — from high temperatures, it can tilt the hormonal balance in fish larva and result in testes development. The overproduction of androgens results in more males developing than females under high temperatures.</p>
<h2>Not just stress</h2>
<p>In <a href="https://doi.org/10.1242/dev.172866">2019</a>, our research group demonstrated that blocking stress receptors through <a href="https://www.nih.gov/news-events/gene-editing-digital-press-kit">gene editing tools</a> completely suppressed fish masculinization induced by high temperatures. These results reveal, for the first time, that the brain acts as a driver of masculinization induced by thermal stress. </p>
<p>In our new study published in <a href="https://doi.org/10.1007/s00018-023-04913-6"><em>Cellular and Molecular Life Sciences</em></a> in 2023, we further demonstrated that thyroid hormones, in addition to stress hormones, are involved in fish masculinization. Once again, through gene editing, we were able to block stress receptors and show that the thyroid hormone pathway is affected when fish experience stress. </p>
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<img alt="Two fish larvae seen close-up." src="https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553544/original/file-20231012-25-xn0fir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&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 larvae of the fish species Centrarchid. Warming temperatures are causing fish larvae to disproportionately develop male sex organs.</span>
<span class="attribution"><span class="source">(Wikimedia Commons)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>It was observed that when cortisol and thyroid hormone production were suppressed through the combined use of chemical drugs, no females were masculinized. Understanding the molecular mechanisms behind fish sex determination helps predict how climate change-induced temperature can affect fish populations in the future.</p>
<h2>Role of pollution</h2>
<p>Several environmental contaminants, like pesticides and plasticizers, are known to <a href="https://doi.org/10.1016/j.envres.2022.112849">upset the balance of hormones in animals</a>. These contaminants — known as endocrine-disrupting chemicals — <a href="https://doi.org/10.1016/j.envres.2021.112584">can lead to sex organs developing abnormally in fish</a>. </p>
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Read more:
<a href="https://theconversation.com/five-options-for-restoring-global-biodiversity-after-the-un-agreement-196835">Five options for restoring global biodiversity after the UN agreement</a>
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<p>With climate change, environmental factors that affect sexual development are now a major issue. Lately, temperatures have been fluctuating drastically, both low and high, exceeding the acceptable range for most fish species. Such changes cause high temperature events, acidification, and hypoxia <a href="https://doi.org/10.1098/rspb.2011.0529">that can distort fish sex ratio</a> by skewing it towards males, and even resulting in all-male fish populations. </p>
<p>In rivers and lakes, the inter-annual events of El Niño or La Niña can also be altered by climate change, which can cause severe periods of flood or drought. This can exacerbate stresses to fish and too few females in a fish population can cause it to collapse, with dire consequences in biodiversity for us all.</p><img src="https://counter.theconversation.com/content/213140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valérie S. Langlois has received funding from the Canada Research Chair Program to conduct this work.
</span></em></p><p class="fine-print"><em><span>Diana Castaneda-Cortes received funding from Doctoral fellow of the CONICET, Argentine National Research Council, 2015-2020. </span></em></p><p class="fine-print"><em><span>Juan Ignacio Fernandino has received funding from the Argentinean National Agency for the Promotion of Science and Technology (AGENCIA) to conduct this work.</span></em></p>Climate change is causing higher levels of stress in fish, and the resulting hormonal imbalances are fundamentally altering entire populations.Valérie S. Langlois, Professor/Professeure titulaire, Institut national de la recherche scientifique (INRS)Diana Castañeda-Cortés, Postdoctoral, Institut national de la recherche scientifique (INRS)Juan Ignacio Fernandino, Associate research scientist, Developmental Biology Laboratory, Instituto Tecnológico de Chascomús (CONICET-UNSAM), Universidad Nacional de San MartínLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151102023-10-12T16:37:24Z2023-10-12T16:37:24ZThe ‘male menopause’ – what you need to know<p><a href="https://www.itv.com/news/central/2023-10-04/nhs-trust-to-give-staff-paid-leave-for-male-menopause">East Midlands Ambulance Service</a> is reportedly giving men up to a year of paid leave for “<a href="https://www.nhsemployers.org/system/files/2021-06/East%20Midland%20Ambulance%20Service%20andropause%20in%20the%20workplace%20guidance.pdf">andropause related issues</a>”, which some are calling the “male menopause”.</p>
<p>This move has <a href="https://www.thetimes.co.uk/article/mariella-frostrup-men-get-your-hands-off-our-menopause-zccdh78hg">angered some commentators</a> who question whether there really is such a thing as the male menopause or “manopause”.</p>
<p>The andropause is not a condition that was recently invented. The medical establishment has been talking about it since <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">the 1940s</a> when it was known as the “male climacteric”. Symptoms of this condition include a lack of energy, weight gain (including “man boobs”), sexual difficulties, sleep problems, anxiety, irritability, depression and even hot flushes.</p>
<p>While many private clinics recognise and treat andropause, it is not recognised as a syndrome by the <a href="https://www.nhs.uk/conditions/male-menopause/">NHS</a>, nor is it usually caused by a radical drop in “male hormones”, such as testosterone. Testosterone levels do naturally decline in men, but the average decrease is around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">1% per year</a> after <a href="https://health.clevelandclinic.org/declining-testosterone-levels/#:%7E:text=The%20average%20drop%20is%20about,1987%2C%201995%20and%202002.">the age of 30</a>. </p>
<p>Less common – only seen in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">6% of adult men under 80</a> – are chronically low levels of testosterone, also known as androgen deficiency. This may result from accidents affecting their testes, experiencing severe illness, or treatment for prostate cancer. </p>
<p>The natural drop in testosterone can be worsened by obesity, extreme stress and some medications or diseases, including drinking too much alcohol. So the andropause is probably more of a lifestyle symptom and therefore should be tackled as such.</p>
<p>The recent media <a>spotlight</a> on female menopause has highlighted just how badly women can be affected by midlife reduction in hormone levels. So much so that the <a href="https://www.theguardian.com/society/2022/apr/24/sajid-javid-appoint-hrt-tsar-acute-shortages-menopause">UK government</a> had to appoint a dedicated “menopause tsar” to deal with the resulting shortage of oestrogel, a popular <a href="https://www.fertifa.com/post/hrt-shortage-and-how-to-get-hrt">form of HRT</a>, as more and more women seek menopause treatment.</p>
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Read more:
<a href="https://theconversation.com/menopausal-women-often-turn-to-doctors-who-know-little-about-the-symptoms-heres-what-needs-to-change-207450">Menopausal women often turn to doctors who know little about the symptoms – here's what needs to change</a>
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<p>The East Midlands Ambulance Service is commendable in wanting to support men in making mid-life lifestyle changes, but calling it the “male menopause” undermines the magnitude of the physiological changes women experience as part of female menopause. </p>
<p>For men, lifestyle <a href="https://www.emerald.com/insight/content/doi/10.1108/WWOP-12-2016-0036/full/html">changes</a> can have huge benefits. Taking care of heart health, exercise and healthy diets <a href="https://pubmed.ncbi.nlm.nih.gov/36697895/">in midlife</a> are known to be good for brain function and can help prevent dementia and heart disease later on.</p>
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<img alt="Middle-aged man stretching in a park." src="https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&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">Exercise can stave off some of the effects of declining male hormones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/staying-active-after-retirement-happy-joyful-2131333251">Evgeny Atamanenko/Shutterstock</a></span>
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<h2>Hormone replacement</h2>
<p>While many women report that taking sex hormones helps with brain problems, actual studies do not show overall long-term benefit of hormone treatment on <a>memory or mood</a>. There are also <a href="https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/">small risks linked with taking hormone therapy</a>. </p>
<p>In contrast, for those who have had their ovaries or testes removed, or take hormone blockers because of cancers, a significant drop in memory and mood can occur and reduced testosterone has been associated with an increased risk for dementia, such as <a href="https://pubmed.ncbi.nlm.nih.gov/21696899/">Alzheimer’s disease</a> and heart disease – the two main causes of death in the UK. </p>
<p>However, it is unclear whether testosterone treatment helps to reduce this risk in men, as some studies showed an increased risk of heart disease, while others found testosterone treatment to be protective or have <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(22)00115-5/fulltext">no effect</a>.</p>
<p>In men with low testosterone levels, overall <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00169-1/fulltext#:%7E:text=We%20observed%20that%20testosterone%20treatment,testosterone%20but%20without%20classic%20hypogonadism">studies</a> suggest that taking testosterone reduced depression and improved erections and libido. There may also be benefits of oestrogen or <a href="https://www.ohsu.edu/sites/default/files/2019-09/CPD%20AMH919-Adams%20handouts.pdf">testosterone</a> gel on sexual function in women. </p>
<p>However, study results have been mixed and caution should always be taken with interpreting the results of research sponsored by the industries producing the treatments. Also, libido is not simply linked to hormones, and a dry vagina or limp penis can be influenced by factors such as relationship stress or work stress – or both.</p>
<h2>The stress effect</h2>
<p>Could andropause be a manifestation of midlife stress? Most likely. And this is not a matter of hormone change. Rather, while dips in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347230/">life satisfaction</a> are only seen in 10-20% of adults in middle age (and often not shown over time), this is probably the result of an evaluation of life at this important new stage.</p>
<p>Importantly, <a href="https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/men-and-mental-health">suicide risk</a> is highest in men between 40 and 49 and is the most common cause of death in men under 50. Many men may mask their depression with alcohol, drugs and overwork. This risk is highest in the poor.</p>
<p>We should applaud the East Midlands Ambulance Service for paying attention to men’s mental health, but maybe not because of the andropause. Rather, interventions that tackle <a href="https://www.glassdoor.co.uk/Salaries/emergency-ambulance-crew-salary-SRCH_KO0,24.htm">poor pay</a>, working conditions, job stress, <a href="https://aace.org.uk/vaa/#:%7E:text=Every%20day%20during%20the%202020,over%20the%20last%20five%20years">public harassment</a> and work-life satisfaction may help improve mental health more than framing these concerns as male menopause.</p>
<p>In the full statement by the East Midlands Ambulance Services, it was made clear that there is no separate or special leave policy for andropause with 12 months off on full pay. Instead, decisions are made on a case-to-case basis, trying to keep staff in work where possible and supporting them with their mental health in a wide variety of ways.</p><img src="https://counter.theconversation.com/content/215110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eef Hogervorst received funding from the Alzheimer's Association and RIA to investigate sex hormone levels and dementia. She also received funding from the British Council Newton Trust to investigate soy and dementia risk. Eef reviewed evidence for dementia risk after taking menopausal HRT for NICE in 2022-2023. </span></em></p><p class="fine-print"><em><span>Emma D'Donnell and Gemma Witcomb 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>Testosterone in men declines at a rate of around 1% a year from age 30. That doesn’t mean that men go through the ‘manopause’.Eef Hogervorst, Professor of Biological Psychology, Loughborough UniversityEmma D'Donnell, Senior Lecturer in Exercise Physiology, Loughborough UniversityGemma Witcomb, Senior Lecturer in Psychology, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085022023-09-05T12:56:59Z2023-09-05T12:56:59ZFive ways to take control of your menstrual cycle and improve your sports performance<figure><img src="https://images.theconversation.com/files/542580/original/file-20230814-25-aydj9i.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taking a proactive approach to your menstrual cycle can help promote your sports performance every day.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-young-woman-lifting-barbells-looking-417189208">Ground Picture/Shutterstock</a></span></figcaption></figure><p>Menstruation is often seen as a negative experience, with symptoms that can be disruptive to daily life. Participation in sport and physical activity is particularly affected, with <a href="https://womeninsport.org/press-release/more-than-1-million-teenage-girls-fall-out-of-love-with-sport/#:%7E:text=Women%20in%20Sport's%20research%20found,them%20take%20part%20in%20activity.">78%</a> of teenage girls reporting they avoid exercise while on their period. </p>
<p>Elite athletes have also <a href="https://www.bbc.co.uk/sport/53705777">reported</a> their performance is negatively affected by their period. So, how do we reduce or manage period-related symptoms? The first step is understanding our menstrual cycle.</p>
<p>There are <a href="https://optimalperiod.com/menstrual-cycle-101/">phases of the menstrual cycle</a>, based upon hormonal fluctuations, where certain symptoms are more frequently experienced. The two main phases are the follicular phase and the luteal phase and they are divided by ovulation. A menstrual cycle should last between 21 and 35 days, with menstruation indicating day one of the cycle and the number of days until the next bleed. Ovulation is approximately half way through the cycle.</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>This is different for those taking hormonal contraceptives, as their natural hormone levels are suppressed by the synthetic hormones and any bleed is known as a “withdrawal bleed”, which is not equivalent to a period.</p>
<p>During the follicular phase, hormone levels are low to begin with. The first three to five days are the time of menstruation and an increase in oestrogen occurs prior to ovulation. For some, this phase provides many positive symptoms of increased confidence, energy and motivation. </p>
<p>After ovulation, hormone levels are higher, with a peak in progesterone and a secondary peak in oestrogen. It is during this time that the menstrual cycle is frequently associated with negative symptoms such as bloating, fatigue and changes in mood.</p>
<p>But we know that menstrual-related symptoms can be improved through diet, sleep, reducing stress and exercising. So taking a proactive approach can help to promote sports performance on every day of the menstrual cycle.</p>
<figure class="align-center ">
<img alt="A hand holds a smartphone which is displaying a menstrual calendar app." src="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541696/original/file-20230808-27-20hbe1.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">There are apps which can help you track your menstrual symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tracking-periods-by-using-menstrual-1940658049">Kaspars Grinvalds/Shutterstock</a></span>
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<h2>1. Track your cycle</h2>
<p>Tracking your menstrual cycle and related symptoms is crucial to taking a proactive approach. Note the first day of your period to check you are having a regular cycle. This is an <a href="https://pubmed.ncbi.nlm.nih.gov/32707266/">important marker</a> for both reproductive and holistic health. </p>
<p>Record any <a href="https://optimalperiod.com/menstrual-cycle-101/">symptoms</a> such as stomach cramps, fatigue and tiredness, changes in mood, anxiety and breast tenderness, along with life events. This helps to determine what’s caused by the menstrual cycle as opposed to other factors. </p>
<p>Complete this for at least three cycles to identify your own pattern. Everyone has a unique experience of the menstrual cycle and related symptoms. </p>
<p>See a doctor if your cycle consistently lasts less than 21 days, is longer than 35 days or absent for three months or more, after the first two years of having periods. If any symptoms are debilitating and affect your daily activities, this is not normal and you need to seek medical advice.</p>
<h2>2. Improve your diet and hydration</h2>
<p>Eat a <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/">well-balanced diet</a>, because this will help give you the energy for training and sport, while also reducing bloating and managing <a href="https://optimalperiod.com/exploring-symptoms-3-what-causes-food-cravings-with-top-tips-on-management/">cravings</a>. </p>
<p>If you train hard, ensure you are <a href="https://optimalperiod.com/wp-content/uploads/2023/02/FAH-carbohydate.pdf">fuelling your training</a> appropriately to support your menstrual cycle. This changes according to what activity you’re participating in. For example, for high intensity workouts, you will need some quick releasing carbohydrate such as a banana or an energy drink during your session, as well as before and after.</p>
<p>If you can, don’t eat too many processed foods such as takeaways, sugary drinks and crisps. Try to eat at least five portions of fruit and vegetables every day. Batch cooking meals can help achieve this – have food prepared in the freezer ready for when you are tired, lacking motivation or short on time. </p>
<p>Drinking plenty of water is also important, as it will help to reduce bloating. </p>
<h2>3. Get better sleep</h2>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079200901382">Sleep</a> is vital because a lack of sleep or poor sleep quality can make many menstrual cycle-related symptoms <a href="https://www.semanticscholar.org/paper/The-Relationship-of-Premenstrual-Syndrome-Symptoms-A%C5%9Fc%C4%B1-G%C3%B6kdemir/cb2222a23d05cf64f804bbcab9a2d730437b6176">worse</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988893/">Sleep hygiene</a> strategies can help prevent symptoms. These include going to bed and getting up at a similar time each day, starting the day with sunlight and limiting your caffeine intake (especially in the afternoon).</p>
<h2>4. Reduce your stress</h2>
<p><a href="https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/">Stress</a> increases the severity and duration of symptoms related to the menstrual cycle and is therefore an important factor to manage. </p>
<p>This is individual and finding a strategy that works for you will differ from person to person. Some ways to reduce stress could include socialising with friends, or meditating. Plan these in advance to prevent stress rather than reacting once you are already stressed.</p>
<h2>5. Stay active</h2>
<p>Sometimes getting to training is the hardest part when experiencing menstrual-related symptoms. Consider other activities such as walking or yoga to manage symptoms like stomach cramps while you are implementing the above strategies. And if there are days when you have more energy and motivation, maximise them while you are getting to understand your menstrual cycle.</p>
<p>You can use heat and pain relief for symptoms such as stomach cramps. Have these to hand if stomach cramps are affecting your ability to train around the time of menstruation. You could also speak to your trainer to adapt a session if required.</p>
<p>The menstrual cycle has long been seen as a negative thing. And there has not been enough information on how to manage symptoms. But we must change that narrative. Symptoms can be managed or reduced so you can continue to participate in sports and other activities. Don’t feel ashamed of your period – take control and be proactive in managing it.</p><img src="https://counter.theconversation.com/content/208502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Brown is affiliated with Arc'Teryx. </span></em></p>Understanding our menstrual cycle and taking a proactive approach to our periods is vital to improving sports performance.Natalie Brown, Research officer for the Welsh Institute of Performance Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2090042023-08-18T10:06:20Z2023-08-18T10:06:20ZHow tracking menopause symptoms can give women more control over their health<figure><img src="https://images.theconversation.com/files/540127/original/file-20230731-234595-td2ntl.jpg?ixlib=rb-1.1.0&rect=32%2C5%2C3566%2C2343&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can track your menopause symptoms by using an app, a dedicated website or a diary. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ny-usa-2-may2022young-fitness-woman-2157077103">Krotnakro/Shutterstock</a></span></figcaption></figure><p>Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them.</p>
<p>People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. </p>
<p>The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important.</p>
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<img alt="A word cloud displaying the symptoms of menopause." src="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540140/original/file-20230731-191965-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&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="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/menopause-symptoms-tags-cloud-estrogen-level-1017507085">Double Brain/Shutterstock</a></span>
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<p><a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. </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>The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry.</p>
<p>There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. </p>
<p>The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. </p>
<p>As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. </p>
<p>One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” </p>
<h2>Why does monitoring symptoms help?</h2>
<p>One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. </p>
<p>Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms.</p>
<p>Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. </p>
<p>Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. </p>
<p>Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.</p><img src="https://counter.theconversation.com/content/209004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lancastle consults to Gedeon Richter, Theramex, Merck Serono and Health and Her. The links with Theramex and Merck Serono are prior to 2020.
She has received honoraria and expenses from Gedeon Richter, Theramex, and Merck Serono for presentations and CPD events. The menopausal symptom monitoring research was funded by a KESS studentship for my PhD student (Robin Andrews), which included company partner funding from Health and Her, and I have provided web-support articles for Health and Her. The studies discussed in this article did not involve Health and Her clients and was not administered via the Health and Her organisation. Health and Her were not involved in the analysis or write up of the studies discussed in this article. </span></em></p>Tracking the many physical and emotional symptoms of menopause with a website, app or diary can help women better monitor their health.Deborah Lancastle, Associate Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088022023-08-17T10:50:21Z2023-08-17T10:50:21ZHow biological differences between men and women alter immune responses – and affect women’s health<figure><img src="https://images.theconversation.com/files/539557/original/file-20230726-21-jhiwex.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3849%2C2568&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/wooden-cubes-image-male-female-gender-2175270281">Fida Olga/Shutterstock</a></span></figcaption></figure><p>Most people will have heard the term “man flu”, which refers to men’s perceived tendency to exaggerate the severity of a cold or a similar minor ailment. </p>
<p>What most people may not know is that, generally speaking, women mount stronger <a href="https://pubmed.ncbi.nlm.nih.gov/36121220/">immune responses</a> to infections than men. Men are <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005374">more susceptible</a> to infections from, for example, HIV, hepatitis B, and <em>Plasmodium falciparum</em> (the parasite responsible for malaria). </p>
<p>They can also have more severe symptoms, with evidence showing they’re more likely to be <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005374">admitted to hospital</a> when infected with hepatitis B, tuberculosis, and <em>Campylobacter jejuni</em> (a bacteria that causes gastroenteritis), among others.</p>
<p>While this may be positive for women in some respects, it also means women are at <a href="https://www.nature.com/articles/nri2815">greater risk</a> of developing chronic diseases driven by the immune system, known as immune-mediated inflammatory diseases.</p>
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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/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/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/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>Here we will explore how biological factors influence immune differences between the sexes and how this affects women’s health. While we acknowledge that both sex and gender may affect immune responses, this article will focus on biological sex rather than gender. </p>
<h2>Battle of the sexes</h2>
<p>There are differences <a href="https://www.nature.com/articles/nri.2016.90">between the sexes</a> at every stage of the immune response, from the number of immune cells, to their degree of activation (how ready they are to respond to a challenge), and beyond.</p>
<p>However, the story is more complicated than that. Our immune system evolves throughout our lives, learning from past experiences, but also responding to the physiological challenges of getting older. As a result, <a href="https://www.nature.com/articles/nri.2016.90">sex differences</a> in the immune system can be seen from birth through puberty into adulthood and <a href="https://academic.oup.com/jleukbio/advance-article/doi/10.1093/jleuko/qiad053/7190870">old age</a>.</p>
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Read more:
<a href="https://theconversation.com/discovery-of-gene-associated-with-20-autoimmune-diseases-leads-to-promising-drug-trials-131957">Discovery of gene associated with 20 autoimmune diseases leads to promising drug trials</a>
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<p>Why do these differences occur? The first part of answering this question involves the X chromosome. Females have two X chromosomes, while males have one X and one Y chromosome. The <a href="https://pubmed.ncbi.nlm.nih.gov/20651746/">X chromosome</a> contains the largest number of immune-related genes. </p>
<p>The X chromosome also has <a href="https://link.springer.com/article/10.1007/s00018-020-03526-7">around 118 genes</a> from a gene family that are able to stop the expression of other genes, or change how proteins are made, including those required for immunity. These gene-protein regulators are known as microRNA, and there are only <a href="https://pubmed.ncbi.nlm.nih.gov/24808907/">two microRNA genes</a> on the Y chromosome.</p>
<p>The X chromosome has <a href="https://www.genome.gov/about-genomics/fact-sheets/X-Chromosome-facts">more genes overall</a> (around 900) than the Y chromosome (around 55), so female cells have evolved to switch off one of their X chromosomes. This is not like turning off a light switch, but more like using a dimmer. </p>
<p>Around <a href="https://bmcgenomics.biomedcentral.com/articles/10.1186/s12864-019-5507-6">15-25% of genes</a> on the silenced X chromosome are expressed at any given moment in any given cell. This means female cells can often express more immune-related genes and gene-protein regulators than males. This generally means a faster clearance of pathogens in females than males.</p>
<figure class="align-center ">
<img alt="Three women laughing together outdoors." src="https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539933/original/file-20230728-19-fesqbz.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">Women have two X chromosomes, which partly explains why the female immune system works differently.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-female-friends-socializing-backyard-together-583329838">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>Second, men and women have <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2020.604000/full">varying levels</a> of different sex hormones. Progesterone and testosterone are broadly considered to limit immune responses. While both hormones are produced by males and females, progesterone is found at higher concentrations in non-menopausal women than men, and testosterone is much higher in men than women. </p>
<p>The role of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533072/">oestrogen</a>, one of the main female sex hormones, is more complicated. Although generally oestrogen <a href="https://www.sciencedirect.com/science/article/abs/pii/S000887491500026X?via%3Dihub">enhances immune responses</a>, its levels vary during the menstrual cycle, are high in pregnancy and low after menopause. </p>
<p>Due in part to these genetic and hormonal factors, pregnancy and the years following are associated with heightened immune responses to external challenges such as infection. </p>
<p>This has been regarded as an <a href="https://www.nature.com/articles/nri.2016.90">evolutionary feature</a>, protecting women and their unborn children during pregnancy and enhancing the mother’s survival throughout the child-rearing years, ultimately ensuring the survival of the population. We also see this pattern in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628977/">other species</a> including insects, lizards, birds and mammals. </p>
<h2>What does this all mean?</h2>
<p>With women’s heightened immune responses to infections comes an increased risk of certain diseases and prolonged immune responses after infections.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/">estimated 75-80%</a> of all immune-mediated inflammatory diseases <a href="https://pubmed.ncbi.nlm.nih.gov/32542149/">occur in females</a>. Diseases more common in women include multiple sclerosis, <a href="https://www.nature.com/articles/nri2815">rheumatoid arthritis</a>, lupus, Sjogren’s syndrome, and <a href="https://www.nature.com/articles/nri.2016.90">thyroid disorders</a> such as Graves disease.</p>
<p>In these diseases, the immune system is continuously fighting against what it sees as a foreign agent. However, often this perceived threat is not a foreign agent, but cells or tissues from the host. This leads to tissue damage, pain and immobility.</p>
<p>Women are also prone to chronic inflammation following infection. For example, after infections with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818468/">Epstein Barr virus</a> or <a href="https://www.liebertpub.com/doi/10.1089/jwh.2008.1193">Lyme disease</a>, they may go on to develop <a href="https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/">chronic fatigue syndrome</a>, another condition that affects more women than men.</p>
<p>This is one possible explanation for the heightened risk among <a href="https://www.frontiersin.org/articles/10.3389/fresc.2023.1122673/full">pre-menopausal women</a> of developing long COVID following infection with SARS-CoV-2, the virus that causes COVID. </p>
<p>Research has also revealed the presence of auto-antibodies (antibodies that attack the host) in patients with long COVID, suggesting it might be an <a href="https://www.sciencedirect.com/science/article/pii/S1568997221000550">autoimmune disease</a>. As women are more susceptible to autoimmune conditions, this could potentially explain the sex bias seen. </p>
<p>However, the exact causes of long COVID, and the reason women may be at greater risk, are yet to be defined. </p>
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<strong>
Read more:
<a href="https://theconversation.com/long-covid-female-sex-older-age-and-existing-health-problems-increase-risk-new-research-185911">Long COVID: female sex, older age and existing health problems increase risk – new research</a>
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<p>This paints a bleak picture, but it’s not all bad news. Women typically mount <a href="https://pubmed.ncbi.nlm.nih.gov/24966191/">better vaccine responses</a> to several common infections (for example, influenza, measles, mumps, rubella, hepatitis A and B), producing higher antibody levels than men. </p>
<p>One study showed that women vaccinated with half a dose of flu vaccine produced the same amount of antibodies compared to men vaccinated with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/773453">a full dose</a>. </p>
<p>However, these responses <a href="https://www.nature.com/articles/nri.2016.90">decline as women age</a>, and particularly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954964/">after menopause</a>. </p>
<p>All of this shows it’s vital to consider sex when designing studies examining the immune system and treating patients with immune-related diseases.</p><img src="https://counter.theconversation.com/content/208802/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen McGettrick receives funding from the Medical Research Council, Biotechnology and Biological Sciences Research Council, Wellcome Trust, F Hoffmann-La Roche Ag, Versus Arthritis, Dompè Pharmaceuticals Ltd, Novartis, Chernajovsky Foundation, British Heart Foundation, Pfizer. </span></em></p><p class="fine-print"><em><span>Asif Iqbal receives funding from, Wellcome Trust, F Hoffmann-La Roche, Chernajovsky Foundation, British Heart Foundation. </span></em></p>Women are more likely to develop chronic diseases driven by the immune system.Helen McGettrick, Reader in Inflammation and Vascular Biology, University of BirminghamAsif Iqbal, Associate Professor in Inflammation Biology, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077562023-07-18T14:32:17Z2023-07-18T14:32:17ZMale fertility crisis: what environmental contaminants have got to do with it<figure><img src="https://images.theconversation.com/files/537480/original/file-20230714-17-hkfcq9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7487%2C4976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are multiple causes of male infertility.</span> <span class="attribution"><span class="source">Jacob Lund/Shutterstock</span></span></figcaption></figure><p>The World Health Organisation (WHO) <a href="https://www.who.int/news-room/fact-sheets/detail/infertility">recently reported</a> that around one in six couples globally are affected by infertility. For many years people tended to blame women for a couple’s infertility – especially in <a href="https://academic.oup.com/humrep/article/27/5/1383/696393">African countries</a>. </p>
<p>But it’s now known that male factor infertility contributes about 50% of total cases. And men worldwide – <a href="https://www.ajol.info/index.php/ahs/article/view/158723">Africa included</a> – are experiencing a <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01054-0">worrying trend</a> of decreased sperm count and quality. </p>
<p>There are multiple causes of male infertility. However, it is clear that <a href="https://www.tandfonline.com/doi/full/10.1016/j.aju.2017.12.004">environmental contaminants</a> play a large part in declining fertility worldwide. Concern is rising about substances such as per- and polyfluoroalkyl substances, nanomaterials and endocrine disrupting compounds. These substances are found everywhere in modern <a href="https://portal.ct.gov/DEEP/Remediation--Site-Clean-Up/Contaminants-of-Emerging-Concern/Contaminants-of-Emerging-Concern#:%7E:text=According%20to%20EPA%2C%20an%20emerging,a%20new%20pathway%20to%20humans.">everyday lives</a>. Most are present in personal-care products such as soaps, shampoos and hair sprays, as well as food wrap, water bottles and many other items. </p>
<p>Other contaminants that are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969721036974?via%3Dihub">increasing</a> in prevalence and show signs of entering our food chain are pesticides and medication. Recent <a href="https://www.mdpi.com/2305-6304/11/4/330">research</a> in our laboratory found high traces of these in the nearshore marine environment of False Bay, as well as in rivers and air in agricultural areas of South Africa’s Western Cape province. </p>
<p>Our study suggests that these “contaminants of emerging concern” might be contributing to the male infertility crisis in surprising ways.</p>
<p>In our study, we described the effects of contaminants such as pharmaceuticals and pesticides on male reproduction. We propose that these can affect men’s reproductive fitness either by interacting with their brain, or by targeting the reproductive organs such as the testes directly.</p>
<p>The public needs to be aware of the effects of contaminants in the environment on reproductive health. Our research could assist in finding a possible cause of unexplained infertility. It may also lead to preventive treatments. </p>
<h2>Impact on male fertility</h2>
<p>Our research suggests that across animals, including humans, most contaminants of emerging concern interfere with hormone function. They target the hypothalamic-pituitary-gonadal axis. </p>
<p>The axis is the part of the <a href="https://www.epa.gov/endocrine-disruption/overview-endocrine-system#:%7E:text=The%20endocrine%20system%2C%20made%20up,the%20metabolism%20and%20blood%20sugar">endocrine system</a> that controls reproductive functions – the ability to produce sperm in men and eggs in women. When the axis is disrupted, reproductive hormones aren’t released as normal. This influences the rate and quality of sperm production.</p>
<p>We report that contaminants of emerging concern can also act directly on testicles by disrupting the blood-testis barrier. This physical barrier protects the developing sperm from harmful substances that may be present in the bloodstream. Once contaminants cross the barrier, these compounds move into the compartments of the testis where sperm are produced and can interact with the cells that are involved in sperm production. These cells also play important roles in regulating the production of hormones such as testosterone. Contaminants can either directly damage these cells or interfere with their function.</p>
<p>The contaminants can also directly damage the DNA in the sperm cells, leading to genetic changes that can affect the quality of the sperm and their ability to fertilise an egg. This can result in infertility or compromise the health of the resulting children.</p>
<h2>The legacy of fathers</h2>
<p>The way environmental factors affect fertility and cause effects over multiple generations may involve the <a href="https://pubmed.ncbi.nlm.nih.gov/23955672/#:%7E:text=The%20sperm%20epigenome%20is%20unique,be%20compacted%20and%20highly%20organized.">epigenome of sperm</a>. The mechanisms are far from being fully understood. But these epigenetic marks can affect how the genes within sperm work without changing the underlying <a href="https://www.mdpi.com/1422-0067/23/6/3350">DNA sequence</a>. </p>
<p>Yet, these changes can be passed down from a parent to their child. This can happen in two ways: when the germ cells that make sperm are exposed to contaminants of emerging concern, and when the sperm itself is affected. In both cases, epigenetic changes can be passed on to future generations who have not been directly exposed to the contaminants. </p>
<p>One category of compounds whose <a href="https://www.tandfonline.com/doi/full/10.1080/15287394.2020.1786483">impact</a> on epigenetic marks that has been <a href="https://onlinelibrary.wiley.com/doi/10.1002/tox.22819">extensively</a> <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-017-0376-9">studied</a> is nonsteroidal anti-inflammatory drugs such as paracetamol and ibuprofen. These drugs are used for managing pain and inflammation. </p>
<p>But our research suggests that they also have adverse effects on reproductive health in children. For example, exposure to these pharmaceuticals during pregnancy can lead to reduction in testosterone levels and changes in genes involved in neurodevelopment in boys. Further <a href="https://www.frontiersin.org/articles/10.3389/fgene.2022.929471/full">studies</a> have also <a href="https://academic.oup.com/eep/article/5/2/dvz008/5499083">suggested</a> that when adults were exposed to insecticides their sperm carried marks in genes involved in neurological functions including susceptibility to autism spectrum disorders, schizophrenia and bipolar disorder. </p>
<p>These effects may be particularly significant when exposure to contaminants of emerging concern is cumulative. And that’s often the case. These contaminants can accumulate in the environment and enter our bodies in various ways, through diet, drinking water, and exposure at work or in recreation. </p>
<p>But there might be solutions to limit their exposure.</p>
<h2>Taking charge</h2>
<p>The numerous pathways in which contaminants of emerging concern contaminate soil, water and air are apparent. But it’s not easy to detect and eradicate these contaminants. So how do we reduce our exposure to them?</p>
<p>Current control measures include regulatory frameworks to limit the use of certain <a href="https://www.foodfocus.co.za/home//Legislation/Food-Safety/AMENDMENT-TO-REGULATIONS-GOVERNING-THE-MAXIMUM-LIMITS-FOR-PESTICIDE-RESIDUES">pesticides</a> <a href="https://www.who.int/publications/i/item/9789240014770">or</a> <a href="https://www.oncotarget.com/article/12956/text/">pharmaceuticals</a>, and develop safer alternatives. There are personal protective measures to take, such as using air and water filters, and reducing the use of plastic products that may contain contaminants of emerging concern.</p>
<p>Public health campaigns could raise awareness about the risks of exposure, or the development of new technologies that can detect and quantify these contaminants in the environment more accurately.</p>
<p>Individuals, especially men, should be made aware of the rise in male infertility and how improving their own health and avoiding exposure to contaminants can increase their chances of fatherhood.</p><img src="https://counter.theconversation.com/content/207756/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>For many years women were blamed for a couple’s infertility. But it’s now known that male factor infertility contributes to about 50% of total cases.Daniel Marcu, PhD Researcher in Reproduction and Genetics, University of East AngliaLiana Maree, Senior Lecturer, University of the Western CapeShannen Keyser, Lecturer, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048012023-06-05T02:11:04Z2023-06-05T02:11:04ZHot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms<figure><img src="https://images.theconversation.com/files/528787/original/file-20230529-15-uxzrwj.jpg?ixlib=rb-1.1.0&rect=35%2C11%2C7904%2C5273&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/woman-walking-towards-shelf-searching-cold-1847405071">Shutterstock</a></span></figcaption></figure><p>While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. </p>
<p>Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. </p>
<p>While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. </p>
<p>But do they work? Or are they a waste of time and considerable amounts of money?</p>
<h2>What’s on the market?</h2>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). </p>
<p>There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. </p>
<p>The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. </p>
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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>
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<h2>What are phytoestrogens?</h2>
<p>Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. </p>
<p>There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. </p>
<p>Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.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>
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<span class="caption">Phytoestrogens can be consumed in foods like tofu or soy milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></span>
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<h2>What does the evidence say?</h2>
<p>In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries.</p>
<p>However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. </p>
<p>Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. </p>
<p>Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. </p>
<p>The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. </p>
<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. </p>
<p>In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. </p>
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Read more:
<a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308">Is menopause making me put on weight? No, but it's complicated</a>
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<h2>Can phytoestrogens help the psychological symptoms of menopause?</h2>
<p>Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. </p>
<p>A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. </p>
<p>Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog.</p>
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<h2>The bottom line</h2>
<p>At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. </p>
<p>If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. </p>
<p>Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. </p>
<p>Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.</p><img src="https://counter.theconversation.com/content/204801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Gurvich has received funding from the NHMRC, the Rebecca Cooper Foundation and Perpetuel Trustees.</span></em></p><p class="fine-print"><em><span>Jane Varney receives funding from the Medical Research Future Fund. </span></em></p><p class="fine-print"><em><span>Jayashri Kulkarni receives funding from NHMRC, and has received honoraria from Servier , Janssen, Lundbeck pharmaceutical industries. She has also received two honoraria from Swisse, H&H companies.</span></em></p>The most popular supplements for hot flushes are phytoestrogens (or plant estrogens). This trend has been partly driven by companies that promote them as a safer alternative to hormone therapy.Caroline Gurvich, Associate Professor and Clinical Neuropsychologist, Monash UniversityJane Varney, Senior Research Dietitian in the Department of Gastroenterology, Monash UniversityJayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2031622023-04-30T20:02:48Z2023-04-30T20:02:48ZNo, you can’t blame all your health issues on ‘high cortisol’. Here’s how the hormone works<figure><img src="https://images.theconversation.com/files/522916/original/file-20230426-16-47kfra.jpg?ixlib=rb-1.1.0&rect=81%2C576%2C5826%2C3431&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/FVRTLKgQ700">Kinga Howard/Unsplash</a></span></figcaption></figure><p>Have you been craving certain foods and gaining weight? Maybe you’re fatigued and can’t concentrate, then wake up in the middle of the night. The latest <a href="https://www.womenshealthmag.com/health/a43010856/balancing-cortisol-levels-tiktok/">TikTok wellness trend</a> would have you believe high cortisol levels are to blame.</p>
<p>It’s true that cortisol affects our weight, energy balance, metabolism and sleep. But so do <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">thyroid</a> hormones, <a href="https://theconversation.com/chemical-messengers-how-hormones-make-us-feel-hungry-and-full-35545">appetite</a> hormones and <a href="https://theconversation.com/chemical-messengers-how-hormones-help-us-sleep-44983">sex</a> hormones, as well as diet and physical activity. </p>
<p>Cortisol also does more than this and regulates many other biological functions. It affects nearly all the cells of our body and is essential for survival.</p>
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<p><iframe id="tc-infographic-847" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/847/49670dd23fbe6ea3c64995f1b7a0cbc85f9e4fb3/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
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<h2>Why is cortisol portrayed as bad?</h2>
<p>Some of what is being blamed on cortisol are symptoms of chronic stress or depression – which makes sense, since these are linked.</p>
<p>Cortisol is the main “stress hormone” of the body. This might make people think cortisol is bad for them, but this is not the case. </p>
<p>Stress is an inevitable part of life, and our stress response has evolved as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867107/">survival mechanism</a> so we can react quickly to dangerous situations. Both psychological and physical stresses elicit the <a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00127/full">stress response</a>.</p>
<h2>Cortisol is essential for a healthy stress response</h2>
<p>Our immediate reaction to a sudden threat is the fight-or-flight response. Adrenaline is released from the adrenal glands into our bloodstream. This instantly increases our heart rate and breathing rate so we can be ready to act quickly to escape or avoid danger. However, the adrenaline response is only very short-lived. </p>
<p>When a threat or stress persists for minutes rather than seconds, cortisol is released from the adrenal glands. Its main role is to increase blood glucose (sugar) for energy. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/three-reasons-to-get-your-stress-levels-in-check-this-year-86764">Three reasons to get your stress levels in check this year</a>
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<p>Cortisol <a href="https://www.ncbi.nlm.nih.gov/books/NBK538239/">affects</a> the liver, muscle, fat and pancreas to increase glucose production and mobilise stored glucose. This increases glucose to the brain so that we are mentally alert and to the muscles so we can move. </p>
<p>In a healthy and normal stress response, cortisol rises quickly in response to the stress and then rapidly reduces back to baseline levels after the stress has passed. </p>
<p>However, chronic stress and ongoing increased cortisol secretion are not healthy. Chronic stress can cause dysregulated cortisol secretion: when cortisol remains high even in the absence of an immediate stress. </p>
<p>It can take weeks for cortisol dysregulation to <a href="https://www.embopress.org/doi/full/10.15252/msb.20209510">return to normal</a> after chronic stress.</p>
<h2>What’s the link with depression?</h2>
<p>Emerging evidence suggests chronic stress and dysregulated cortisol may contribute to the <a href="https://www.mdpi.com/2076-3425/11/10/1298#:%7E:text=Increased%20HPA%20axis%20activity%20can,cognitive%20dysfunction%20and%20reduced%20mood.">development of depression</a>. Our research team <a href="https://pubmed.ncbi.nlm.nih.gov/29096223/">has shown</a> that people with depression have, on average, higher cortisol than people who don’t have depression. We also found that higher cortisol was associated with <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00971/full">more negative thinking</a> and lower <a href="https://link.springer.com/article/10.1007/s11136-019-02236-3">quality of life</a>.</p>
<p>The symptoms described on TikTok as being due to high cortisol may be caused by stress, depression or anxiety. Depression can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176119/">cause</a> insomnia, increased appetite, and weight gain or loss. </p>
<figure class="align-center ">
<img alt="Man looks at sugary drinks at the supermarket" src="https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522917/original/file-20230426-419-s8qq58.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">Tiredness and cravings can be caused by a number of different things.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/VHMvdS720Hc">Unsplash/Atoms</a></span>
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<p>The <a href="https://www.sciencedirect.com/science/article/pii/S2666497621000412">relationship</a> between cortisol, weight changes and depression are complex. High cortisol also increases the activity of adrenaline. This explains why when you are stressed you can be extra reactive and snap into fight-or-flight mode quickly.</p>
<p>However, some of the symptoms described on TikTok as due to “high cortisol” may actually reflect low cortisol. Low cortisol can be <a href="https://theconversation.com/stressed-female-infants-may-become-anxious-teens-10683">caused by</a> chronic stress and high cortisol during childhood or earlier in life. This is why some people with depression, particularly those with a long history of depression, have low rather than high cortisol. </p>
<p>Low cortisol causes fatigue and weight gain. This is <a href="https://pubmed.ncbi.nlm.nih.gov/30071417/">more common</a> in women and we found this was linked to leptin, a satiety hormone. </p>
<h2>How do you know if your cortisol is too high or low?</h2>
<p>Despite claims on TikTok, we cannot tell whether our cortisol is in balance or high or low. </p>
<p>The only way to know is to have your blood, urine or saliva analysed in a laboratory. This is not done routinely and would be a waste of resources. A doctor would only check this if they suspected you had a disorder of cortisol production, but these are rare.</p>
<p>Besides, your cortisol levels vary considerably across different times of the day and night. </p>
<h2>Cortisol affects your body clock</h2>
<p>One of the most important roles of cortisol is in the circadian system of the body. The hypothalamus in the brain sets the circadian (approximately 24-hour) rhythms of our biological functions to match the light-dark cycle. Cortisol communicates these signals from the brain to the rest of the body. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chemical-messengers-how-hormones-help-us-sleep-44983">Chemical messengers: how hormones help us sleep</a>
</strong>
</em>
</p>
<hr>
<p>Cortisol secretion from the adrenal glands increases in the early hours of the morning, peaks at about 7am, and then is lowest from about midday until early morning. </p>
<p>Cortisol is our body’s natural alarm clock. Higher cortisol during the morning or at the end of the sleep period stimulates wakefulness, increased energy, and physical activity. Lower cortisol during the night encourages sleep and restorative functions.</p>
<h2>How can you maintain healthy cortisol levels?</h2>
<p>You can try to maintain healthy levels of cortisol by addressing the underlying causes of cortisol dysregulation.</p>
<p>Meditation, mindfulness and cognitive behavioural therapy <a href="https://theconversation.com/its-not-all-in-your-mind-how-meditation-affects-the-brain-to-help-you-stress-less-97777">can reduce</a> the reactivity of the stress response. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688585/">Exercise</a> during the day and <a href="https://theconversation.com/health-check-three-reasons-why-sleep-is-important-for-your-health-41176">good sleeping habits</a> also help to reduce chronic stress and high cortisol. </p>
<p>Finally, a healthy balanced diet gives your body the building blocks for good hormone health.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/203162/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>Some of what is being blamed on cortisol are symptoms of chronic stress or depression – which makes sense, since they’re linked.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongSusan J Thomas, Associate professor, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2038642023-04-18T16:12:00Z2023-04-18T16:12:00ZBirth control study suggests oestrogen dosage could be drastically cut – here’s what you should know<figure><img src="https://images.theconversation.com/files/521575/original/file-20230418-26-e046v7.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5607%2C3715&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/contraceptive-pill-174199502">Image Point Fr/ Shutterstock</a></span></figcaption></figure><p>The amount of oestrogen the birth control pill currently contains is already <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/">substantially lower</a> than it was when the pill was first licensed more than 60 years ago. But a new paper has suggested that the doses of both oestrogen and progestogen in the pill could be significantly reduced and <a href="https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1010073#abstract0">still work to prevent pregnancy</a>.</p>
<p>Given the many <a href="https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/birth-control-pill-side-effects">side effects</a> that can come from using contraceptives, researchers wanted to know whether birth control could still work even if hormone dosages were lower. </p>
<p>To conduct their study, the team of researchers developed a very complex mathematical model using data on hormone levels from 23 women with normal menstrual cycles. They were then able to use this information to calculate what effect altering the timing and doses of certain hormones could have in preventing ovulation. </p>
<p>The model predicted that giving a very short, moderate dose of oestrogen around the seventh day of a 28-day cycle – either with or without a low dose of continuous progesterone – was capable of stopping ovulation. This meant that the dose of oestrogen needed to stop ovulation could be reduced by over 92%, while the dose of progesterone in progestogen-only methods could be reduced by 43%. </p>
<h2>Hormone dosages</h2>
<p>As exciting as these findings may be, there are a couple of major caveats to this research when it comes to real-world application.</p>
<p>First, it’s important to understand that these findings are based on computer modelling – not real-world data. Most new contraceptive methods are tried first on <a href="https://slate.com/news-and-politics/2011/08/how-they-run-clinical-trials-of-contraceptives.html">animal models, then in human volunteers</a>. It’s very possible that these computer models will reflect real-world results, but much more research will be needed in order to understand whether very precise low-dose hormonal contraceptives actually work in humans. </p>
<p>Second, the model was built using a simulated 28-day menstrual cycle. But menstrual cycle length can <a href="https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/">vary greatly between women</a>. As such, it’s uncertain whether these results will be true for women who have different menstrual cycle lengths. </p>
<p>Another limitation of the model that the researchers point out is that reducing contraceptive hormone levels only appears to work for about four simulated menstrual cycles. After that, the model predicts that ovulation will start to happen again. </p>
<p>This is because stopping ovulation in the previous cycle adjusts the length of the next cycle and the hormone levels associated with it. This in turn affects the time that the next dose needs to be given. So, for very low doses to work in real life, it’s likely that women would need to constantly adjust the time they take hormone dosages to keep the contraceptive working.</p>
<figure class="align-center ">
<img alt="A woman uses a menstrual calendar on her phone to track stages of her cycle." src="https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521578/original/file-20230418-22-x72wkx.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">The simulation found ovulation was only stopped for a few months.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tracking-periods-by-using-menstrual-1940658049">Kaspars Grinvalds/ Shutterstock</a></span>
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</figure>
<p>The researchers suggest that if a device could constantly sample the blood of the user and adjust the timing of a dose of oestrogen each month, this would overcome this problem and the problem of varying cycle lengths between women. Such a device does not yet exist, however.</p>
<p>The oestrogen found in current combined contraceptive methods (such as the pill and patch) also helps to regulate bleeding, and is taken for at least 21 days in every month. We don’t know what effect taking a lower dosage of oestrogen during a specific, much shorter time of the month would have on bleeding in the rest of the menstrual cycle. This is something that future studies will need to investigate. </p>
<h2>The future</h2>
<p>Despite these caveats, these results are exciting because of the benefits that lowering hormone doses could have for those who use birth control. </p>
<p>When the combined contraceptive pill was first introduced in the 1960s, doctors quickly realised that the high doses of oestrogen in the pill <a href="https://peopleshistorynhs.org/encyclopaedia/birth-control-on-the-nhs/">were causing clots, strokes and heart attacks</a> in some women. This led to a reduction of the amount of oestrogen the pills contained. </p>
<p>But although hormone levels are significantly lower now than they were in the past, a small number of women still experience harmful side effects when they take birth control, such as clots in the leg, <a href="https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/">largely because of the oestrogen it contains</a>. Women at increased risks of clots, strokes or heart problems cannot use contraceptive methods involving oestrogen at all. </p>
<p>While many factors contribute to a woman’s risk of harmful side effects from the oestrogen and progestogen found in contraceptives (such as genetics, weight and whether she smokes), it’s generally assumed that some of this risk is due to the level of these hormones that contraceptives contain. That means that lowering the dose of hormones in contraceptive methods has the potential to reduce the small risk of harmful side effects in some women.</p>
<p>This is why the suggestion that the doses of both oestrogen and progesterone could be much lower and still stop ovulation is so interesting. If future research shows these findings to be true in human trials, the next step would then be developing technology that could help ensure women receive the precise hormone dosages at just the right time. This would ensure that her contraceptive worked but with the possibility of minimising the risk of side effects.</p><img src="https://counter.theconversation.com/content/203864/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has previously received funding from Bayer PLC. </span></em></p>A computer modelling study suggests that oestrogen levels could get lowered by as much as 92%.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1986392023-02-16T06:10:43Z2023-02-16T06:10:43ZAt-home fertility tests: here’s what they can actually tell you<figure><img src="https://images.theconversation.com/files/510298/original/file-20230215-18-4vw2gt.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5214%2C3468&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A large proportion of at-home fertility tests are aimed at women.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concentrated-young-mixed-race-woman-unpacking-1477334057">fizkes/ Shutterstock</a></span></figcaption></figure><p>A growing number of us are waiting longer to become parents. In the UK, the average age of first-time parents is <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2020">between 30 and 33 years old</a>. Fifty years ago, the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2017">average age was 26</a>.</p>
<p>There are many reasons we’re choosing to have children later in life. On the one hand, waiting to have kids can allow us to create more stable lifestyles first, establishing a career and building our finances. But many of us also know that the longer we wait, the harder it can be to have children – with age being one of the biggest factors underlying infertility. </p>
<p>Given how big this decision is, it’s no wonder there’s growing interest in at-home fertility tests which are often advertised to people in their 20s and 30s. But while these test kits can provide you with some useful information, they can’t provide you with a full picture of your fertility.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.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><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
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<p><em><a href="https://theconversation.com/five-things-research-can-teach-us-about-having-better-sex-according-to-a-sex-therapist-199360?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five things research can teach us about having better sex, according to a sex therapist</a></em></p>
<p><em><a href="https://theconversation.com/love-languages-might-help-you-understand-your-partner-but-its-not-exactly-science-199040?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘Love languages’ might help you understand your partner – but it’s not exactly science</a></em></p>
<p><em><a href="https://theconversation.com/tailoring-workouts-to-your-menstrual-cycle-may-help-your-physical-fitness-but-only-if-done-properly-195773?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Tailoring workouts to your menstrual cycle may help your physical fitness – but only if done properly</a></em></p>
<hr>
<h2>At-home tests</h2>
<p>For women, peak fertility occurs between their late teens and <a href="https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy#:%7E:text=A%20woman's%20peak%20reproductive%20years,you%20reach%20your%20mid%2D30s.">late 20s</a>. After the age of 35, a woman’s fertility declines more rapidly until, by the age of about 45, getting pregnant naturally <a href="https://www.britishfertilitysociety.org.uk/fei/at-what-age-does-fertility-begin-to-decrease/">becomes unlikely</a>. While fertility also declines in men with age, they don’t experience such a dramatic drop from their mid-30s. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a>
</strong>
</em>
</p>
<hr>
<p>So the best age to conceive is often when having children may be far from a woman’s mind. This may explain the appeal of at-home fertility test kits, which promise to give you a picture of your fertility so you can better plan when you may want to start trying for kids.</p>
<p>A number of these tests are currently aimed at women. This is likely because unlike men, who produce sperm continually from puberty, women are born with all the eggs they will ever have.</p>
<p>Most kits work by having users provide a small blood sample, which is then sent off to a lab to be tested. To get a picture of fertility, these kits typically look at levels of <a href="https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones">specific hormones</a> in the user’s blood – most commonly follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH).</p>
<p>Tests which look at FSH and LH can give a general idea of a woman’s hormonal balance, and can indicate when ovulation may occur. This can help determine when it might be the best time to have sex if you’re trying to get pregnant. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32770239/">AMH</a> levels are used as a marker for the number of eggs remaining in the ovary. So tests which look at AMH levels might be able to indicate if your fertility is declining.</p>
<figure class="align-center ">
<img alt="A lab worker wearing medical gloves holds a test tube of blood in their hand. The tube is labelled 'AMH test'." src="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510301/original/file-20230215-26-px0m2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The information you get will depend on what hormones the test is looking at.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blood-sample-tube-amh-antimullerian-hormone-1934816009">Saiful52/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These tests can tell you about your fertility now, but they can’t predict your fertility in five or ten years’ time. Furthermore, while they can help monitor hormone levels or the number of eggs still in the ovary, they can’t tell a woman <a href="https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/testing_and_interpreting_measures_of_ovarian_reserve.pdf">if she’s infertile</a>.</p>
<p>This is because they don’t measure the quality of a woman’s eggs or detect if she has any physical complications (such as blocked fallopian tubes) preventing her from becoming pregnant. This kind of information can only be shown through other tests, such as an abdominal scan. </p>
<p>Researchers have also recently warned against putting too much emphasis on determining fertility status from just a few, <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">select biological factors</a>. This is because fertility is regulated by a complex array of biological and <a href="https://tfp-fertility.com/en-gb/blog/9-lifestyle-factors-that-affect-fertility">lifestyle factors</a> such as weight, poor diet, smoking and excessive alcohol intake. </p>
<h2>Fertility problems</h2>
<p>While most of these at-home fertility tests are targeted at women, fertility is <a href="https://jamanetwork.com/journals/jama/fullarticle/265681">as much a consideration for men</a> as it is for women. </p>
<p>Approximately one in eight couples are affected by <a href="https://www.nhs.uk/conditions/infertility/">infertility</a>. This is defined as being <a href="https://www.britishfertilitysociety.org.uk/fei/what-is-infertility/">unable to get pregnant</a> after 12 months of regular, unprotected sex.</p>
<p>There are many reasons why infertility may happen, such as hormonal imbalances, problems ovulating, or ovulating eggs of poor quality. In women, <a href="https://www.nhs.uk/conditions/infertility/causes/">prior infections</a> can also be a factor. In men, infertility is often the result of a very low sperm count and can be a consequence of prior infection. But in many cases, the causes are unknown. </p>
<p>Many men may believe that if they can get an erection and ejaculate, there’s no problem with <a href="https://www.healthymale.org.au/news/debunking-myths-male-fertility#:%7E:text=Another%20common%20myth%20around%20men's,their%20partners%20to%20become%20pregnant">their fertility</a>. Men may also believe that age is not as much of <a href="https://www.yourfertility.org.au/everyone/age#:%7E:text=Age%20and%20sperm,healthy%20sperm%20than%20younger%20men.">an issue</a> for their fertility as it is for women. </p>
<p>However, infertility is increasing in men and is seen as a product of our modern lifestyle. Obesity, smoking, poor diet, excessive alcohol intake and recreational drug use have all been linked to <a href="https://www.inverse.com/mind-body/male-infertility-increasing">lower fertility in men</a>. </p>
<p>While men can also purchase home fertility testing kits online, these tests usually only tell you how many sperm you’re producing in each ejaculate. The shape (morphology) and speed (motility) of sperm are also <a href="https://www.mayoclinic.org/diseases-conditions/low-sperm-count/expert-answers/home-sperm-test/faq-20057836">crucial factors</a> in determining a man’s fertility – but these aren’t usually measured by these kits. Undergoing a full clinical semen analysis is still the best way for a man to assess his fertility. </p>
<p>The picture of modern fertility is changing – with fertility rates declining around the world. In many countries, fewer children are being born today than <a href="https://www.weforum.org/agenda/2022/06/global-decline-of-fertility-rates-visualised/#:%7E:text=For%20the%20last%2070%20years,increased%20cost%20of%20raising%20children">60 years ago</a>. Recent studies also show that sperm counts have <a href="https://www.focusonreproduction.eu/article/ESHRE-News-Sperm-count-decline#:%7E:text=The%20latest%20study%20found%20an,century%20at%20an%20accelerated%20pace">decreased by nearly 60%</a>. </p>
<p>However, making some simple lifestyle changes each day may help improve your fertility. For instance, losing weight and avoiding smoking and drinking in excess can all improve a couple’s chance of <a href="https://www.yourfertility.org.au/everyone/drugs-chemicals">getting pregnant</a>.</p>
<p>So if you are thinking of having children – whether in the near future or much later – making changes to your lifestyle is a good place to start if you’re concerned about your fertility.</p><img src="https://counter.theconversation.com/content/198639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins receives funding from the Biotechnology and Biological Sciences Research Council. </span></em></p>At-home tests can only provide a partial picture of your fertility.Adam Watkins, Assistant Professor, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1988852023-02-13T19:13:14Z2023-02-13T19:13:14ZWhat happens in our brain and body when we’re in love?<figure><img src="https://images.theconversation.com/files/508767/original/file-20230208-13-1s2l0s.jpg?ixlib=rb-1.1.0&rect=23%2C31%2C5152%2C3414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/A7Um4oi-UYU">JustinFollis/Unsplash</a></span></figcaption></figure><p>Love dominates our popular culture and is the subject of countless songs, movies, and works of literature and art. But what’s happening in our body when we feel love?</p>
<p>Love is difficult to define, but can be described as an intense feeling of deep affection. At the most basic level, science sees love as a cocktail of chemicals released by the brain. </p>
<p>From an evolutionary perspective, romantic love evolved from the primitive animal drive to find and keep preferred mates. Love <a href="https://theconversation.com/what-is-love-139212">keeps people bonded</a> and committed to one another, to raise children through infancy. This ensures our species will continue to reproduce, survive and thrive. </p>
<p>However, romantic love is not just about reproduction. Some <a href="https://doi.org/10.1016/j.mehy.2019.05.011">argue</a> we should consider love a motivation, like hunger, thirst, sleep or sex. </p>
<p>There are many benefits of loving others and being loved. These <a href="https://theconversation.com/love-is-good-for-us-so-why-do-lawmakers-try-to-break-us-up-131191">include</a> better mental health, wellbeing and immune function, and reduced chronic stress and disease. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-love-139212">What is love?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens when someone initially falls in love?</h2>
<p>Falling in love typically begins when someone starts to see another person as special and unique. </p>
<p>The initial phase of falling in love is an <a href="https://pubmed.ncbi.nlm.nih.gov/27366726/">extreme neurobiological state</a>, characterised by heightened responses and high passion. Lust and attraction are driven by the sex hormones, estrogen and testosterone, as motivations for sex. </p>
<p>Specific areas of the brain are activated when you fall in love, in particular the limbic system and the reward centres. The limbic system has key roles in emotion and memory. This causes a positive mood and explains why the memories associated with new love are so strong. </p>
<figure class="align-center ">
<img alt="A young lesbian couple cuddle in long grass" src="https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508763/original/file-20230208-23-zvpqn.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">Memories of early love are strong because the brain’s limbic system is activated.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/03tSOB03Xko">Masha S/Unsplash</a></span>
</figcaption>
</figure>
<p>There is also an increase in dopamine and noradrenaline. Dopamine stimulates the reward pathways and increases motivation and obsessive thoughts and behaviours to pursue the love interest. Noradrenaline causes the feelings of euphoria, and the physiological responses of a faster heart rate, butterflies in the stomach and increased energy.</p>
<p>At the same time, other brain areas are deactivated. Reduced activity in the frontal cortex reduces negative emotions and judgements. This explains why initially people may be blind to faults in the person they are in love with.</p>
<p>But while you might be feeling less judgement, there is also increased cortisol, stress and feelings of insecurity in the early phase of falling in love. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/love-is-good-for-us-so-why-do-lawmakers-try-to-break-us-up-131191">Love is good for us, so why do lawmakers try to break us up?</a>
</strong>
</em>
</p>
<hr>
<h2>How does romantic love change over time?</h2>
<p>The initial phase of falling in love and intense infatuation lasts for several months. </p>
<p>During the next phase, there is increased intimacy, commitment and attachment. This is driven by the hormones oxytocin and vasopressin. Oxytocin helps us feel safe and secure after the initial high cortisol and stress of the uncertainty and risk of falling in love. Vasopressin promotes behaviours of vigilance and being territorial and self-protective. </p>
<p>Between oxytocin and vasopressin there is a balance of connecting with others while also protecting the person you are in love with and yourself.</p>
<figure class="align-center ">
<img alt="Older couple walk in a forest" src="https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508771/original/file-20230208-20-78hdw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oxytocin helps us feel safe and secure.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/GPJ3VEbEDH4">Alex Blajan/Unsplash</a></span>
</figcaption>
</figure>
<p>Oxytocin is often called the “hormone of love” because it <a href="https://doi.org/10.1016/j.neubiorev.2022.104948">facilitates</a> the formation of social bonds and connections. However, <a href="https://doi.org/10.1016/j.neuron.2022.12.011">new research in animal models</a> suggests oxytocin is not essential for life-long pair-bonding as previously thought.</p>
<p>Sexual activity is distinct from love, but it does reinforce attachment. When we touch, kiss or have sex, oxytocin and vasopressin <a href="https://theconversation.com/whats-the-point-of-sex-its-good-for-your-physical-social-and-mental-health-67848">are released</a>, which promotes love and commitment between a couple. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-point-of-sex-its-good-for-your-physical-social-and-mental-health-67848">What's the point of sex? It's good for your physical, social and mental health</a>
</strong>
</em>
</p>
<hr>
<p>Years into a romantic relationship, there is often a period of <a href="https://pubmed.ncbi.nlm.nih.gov/22119059/">transition</a> from passionate love to companion love. High intimacy and commitment help to sustain this love. Some relationships end at this time because of the reduced passion, while other couples remain in the passionate love phase for decades. </p>
<h2>What about non-romantic love?</h2>
<p>Beyond its role in romantic love, oxytocin is important in <a href="https://doi.org/10.1124/pr.120.019398">all forms of love</a>, including with family, friends and even pets. Positive social relationships and oxytocin have many <a href="https://doi.org/10.1016/j.ijpsycho.2022.07.007">benefits</a> on human health, wellbeing and longevity. </p>
<figure class="align-right ">
<img alt="Person pats cat in bed" src="https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508772/original/file-20230208-13-37gyqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oxytocin plays a role in our love for pets, too.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/mAsKA0jFfeQ">Chris Abney/Unsplash</a></span>
</figcaption>
</figure>
<p>In our research, we <a href="https://www.jstor.org/stable/48705219">have shown</a> oxytocin is associated with better quality of life and <a href="https://doi.org/10.1016/j.psyneuen.2017.10.018">healthier social connections</a>, among people with and without depression. </p>
<p>So, for the love of your favourite person, people or pet(s), whoever they are, however long you love them for, and however many times you fall in love, relish loving and being loved. </p>
<p>Love might just be nature’s best chemical cocktail. But all the intricacies of the complex behaviour and emotion of love <a href="https://theconversation.com/love-is-it-just-a-fleeting-high-fuelled-by-brain-chemicals-129201">continue to elude science</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/love-is-it-just-a-fleeting-high-fuelled-by-brain-chemicals-129201">Love: is it just a fleeting high fuelled by brain chemicals?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/198885/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>At the most basic level, the brain releases a cocktail of chemicals. But there’s more to it than that.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongSusan J Thomas, Associate professor, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966342023-01-08T13:26:53Z2023-01-08T13:26:53ZType 2 diabetes in young people puts their eyes at risk<figure><img src="https://images.theconversation.com/files/501160/original/file-20221214-15950-g5r5q3.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C989%2C654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When it comes to eye care, regular visits to the optometrist or ophthalmologist can detect the early signs of diabetic damage.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sixteen-year-old Karl is seen for the first time in my optometry practice. He was referred to me for a fluctuating vision problem. During his examination, I saw signs suggesting he may have diabetes, which could have explained the fluctuating vision. This suspicion became a reality when his family doctor confirmed the diagnosis. Karl’s world was turned upside down.</p>
<p>As an optometrist, I invite you to dive into a reality that should concern us all.</p>
<h2>What is diabetes?</h2>
<p>Diabetes is an insidious disease. Its symptoms <a href="https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318">(thirst, need to urinate often, fatigue, weight loss, darker skin areas on the neck and underarms)</a> often go unnoticed, at least in the early stages of the disease.</p>
<p>Diabetes affects the lives of <a href="https://data.worldbank.org/indicator/SH.STA.DIAB.ZS?locations=XU">one in 14 people in Canada (7 per cent) and one in 10 in North America (10 per cent)</a>.</p>
<p>Two types of diabetes can be diagnosed:</p>
<ul>
<li><p><a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/type-1-diabetes/">Type 1</a>, which is insulin-dependent and develops when the body cannot produce the insulin needed to metabolize the sugars we ingest and which feed our tissues</p></li>
<li><p><a href="https://www.canada.ca/en/public-health/services/diseases/type-2-diabetes.html">Type 2</a>, which develops when insulin is produced, but in insufficient quantities. Sometimes the insulin that is produced is ineffective in doing its job.</p></li>
</ul>
<p>Type 1 diabetes is usually associated with the development of the disease in childhood and adolescence. Type 2, the most common, usually develops later in life, <a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/">often after age 50</a>.</p>
<h2>A counter-intuitive diagnosis, but not a rare one</h2>
<p>From this definition, it would have been logical to conclude that Karl was affected by Type 1 diabetes, the course and treatment of which are well controlled by physicians. However, in his case, and after the required testing, his doctor identified Type 2 diabetes. This diagnosis is counter-intuitive and poses significant challenges. The speed of onset, the initial severity of the disease and the mechanisms of resistance, or of reduced insulin secretion, may be different in patients who develop the disease at a younger age <a href="https://pubmed.ncbi.nlm.nih.gov/15735201/">than in adults</a>.</p>
<p>In addition, treatment options, involving trial and error, become more complex due to the much longer duration of this type of disease when it starts at a young age. Both major and minor changes <a href="https://pubmed.ncbi.nlm.nih.gov/12090830/">that affect the blood vessels in the Type 2 diabetic patient</a> can have serious consequences that are difficult to predict since the course of treatment can continue for 40 to 60 years.</p>
<p>However, Karl’s situation is not exceptional. <a href="https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(17)30186-9.pdf">More and more young people and adolescents</a>, especially those who are <a href="https://pubmed.ncbi.nlm.nih.gov/12241736/">overweight, obese, and sedentary</a>, are affected by Type 2. Almost 75 per cent of them have <a href="https://www.cdc.gov/diabetes/basics/type2.html">parents or siblings with diabetes</a>.</p>
<p>While at first sight, this confirms genetics as a risk factor for developing the disease, in this specific case, it was more a consequence of <a href="https://www.cdc.gov/diabetes/basics/type2.html">poor lifestyle habits, especially dietary habits, and lack of physical activity</a>, which are often shared by the whole family.</p>
<h2>Impact on vision</h2>
<p>The fact that Karl developed Type 2 diabetes earlier, rather than later in life also puts him at a higher risk of developing eye complications. An <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2786928">article</a> about this topic recently caught my attention. This study looked at the records of 1,362 people with diabetes living in Minnesota, so, in North America and then extrapolate to Canada. The data was compiled between 1970 and 2019, which also allows us to measure the evolution of the situation over the last decades.</p>
<p>The results are astonishing: young people with Type 2 diabetes (compared to Type 1 diabetics of the same age) are 88 times more likely to develop retinopathy (abnormal blood vessels and/or hemorrhages in the retina). In addition, the risk of this retinopathy becoming “proliferative,” and therefore threatening to vision, is increased 230 times. There is also a 49-fold increase in the risk of fluid accumulation in the retina (macular edema) and a 243-fold increase in the risk of developing a mature cataract at a young age. The latter requires surgery which is riskier in young people than in the case of age-related senile cataracts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="photograph of a fundus" src="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?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">Vascular and metabolic complications of diabetes visible on the fundus (hemorrhages, exudates).</span>
<span class="attribution"><span class="source">(Langis Michaud)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>What should we remember from this? That the major problems, which often require surgical interventions to save vision, occur much more rapidly in young Type 2 diabetics than in those affected by Type 1. These patients must therefore be followed more closely. Indeed, almost one in two Type 2 patients will develop some form of retinopathy within one to eight years of diagnosis. In comparison, one in three Type 1 diabetics will develop retinopathy between six and 10 years following diagnosis.</p>
<h2>Significant repercussions</h2>
<p>Already having increased significantly in the last 10 years, the prevalence (number of cases) of Type 2 diabetes in young people is predicted to <a href="https://pubmed.ncbi.nlm.nih.gov/23173134/">quadruple by 2050</a>. This prediction is most alarming for health professionals, but also for policymakers and managers of public health agencies. The lifetime cost of direct medical care for a single diabetic patient aged 25-44 years was <a href="https://pubmed.ncbi.nlm.nih.gov/23953350/">US$125,000 in 2013</a>. These costs have since increased and many more dollars need to be added to cover the period between 15 and 25 years, which is not taken into account. Indeed, if 20 per cent of the youth population develops diabetes by 2050, millions (perhaps billions?) of health-care dollars will have to be spent on their care by our governments.</p>
<p>The long-term quality of life of people with diabetes is also reduced. <a href="https://pubmed.ncbi.nlm.nih.gov/30345893/">Another study</a>, this time of young people with Type 1 diabetes, shows that their disease has a negative impact on their life. They have to devote a lot of time to their care (missing activities with their friends). And the burden of their disease on their relatives weighs heavily on their shoulders. The fear of hypoglycemia (lack of sugar that can lead to coma) or of developing serious complications of the disease also affects them. Achieving autonomy is more difficult for these adolescents, and their quality of life is proportional to the freedom they can or cannot exercise.</p>
<h2>Eat well, exercise and visit your optometrist</h2>
<p>Type 1 diabetes is difficult to prevent, mainly because we don’t know all the reasons why it occurs and to proactively screen for it. The situation is different for Type 2 diabetes, which is strongly associated with unhealthy lifestyle in young people. Eating a healthy diet, exercising regularly, and combating sedentary lifestyles, including limiting screen leisure time (to less than two hours per day), are good ways to avoid or delay the onset of diabetes in young people. Screen time is also associated with <a href="https://pubmed.ncbi.nlm.nih.gov/28288985/">insulin resistance</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31270831/">obesity</a> in young people. In other words, healthy lifestyles must be encouraged and especially shared within the family unit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young children ride bikes" src="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.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">Healthy habits are good ways to avoid or delay the onset of diabetes in young people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As far as eyes are concerned, regular visits to the optometrist or ophthalmologist can detect early signs of diabetic complications <a href="https://guidelines.diabetes.ca/cpg/chapter30">(signs are seen in up to 30 per cent of patients shortly after diagnosis)</a>. These health professionals can also detect other oculo-visual problems arising from the disease, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518369/">loss of ability to focus up close (accommodation), partial paralysis of certain muscles of the eye resulting in double vision, delayed healing of surface corneal changes, dry eye or glaucoma</a>. Testing should be done <a href="https://guidelines.diabetes.ca/cpg/chapter30">at the time of medical diagnosis of diabetes</a>, or in anyone with a high-risk profile (heredity, obesity, sedentary lifestyle).</p>
<p>Since healthy lifestyle habits are an integral part of the treatment of the disease, it is not too late for Karl to enjoy a happier future. But it is important not to neglect regular follow-ups by his medical doctor and frequent visits to his family optometrist.</p><img src="https://counter.theconversation.com/content/196634/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The risk of developing eye complications is high in young people with Type 2 diabetes, which is increasingly affecting children and adolescents, especially those who are more sedentary.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1960162022-12-13T22:56:16Z2022-12-13T22:56:16ZWhy does the Alzheimer’s brain become insulin-resistant?<figure><img src="https://images.theconversation.com/files/499100/original/file-20221205-26-1etuem.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C988%2C555&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Type 2 diabetes, characterised in its advanced stages by insulin resistance, is an important risk factor for Alzheimer's disease.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As the population ages, the number of people with <a href="https://braininstitute.ca/research-data-sharing/neurodegenerative-disorders">neurodegenerative diseases</a>, such as <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s disease</a>, increases. Approximately <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-highlights-canadian-chronic-disease-surveillance.html">75,000 Canadians</a> are diagnosed with Alzheimer’s disease each year and experience a decline in their cognitive abilities. The ordeal usually lasts for several years while their family members watch helplessly.</p>
<p>Neurodegenerative diseases are characterized by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0924977X13001107">proteinopathies</a> — abnormal accumulations of proteins in the brain that impair the functioning of <a href="https://cancer.ca/en/cancer-information/resources/glossary/n/neuron">neurons</a>. The most widely studied therapeutic approach to developing drugs for Alzheimer’s is to try to reduce the aggregation of <a href="https://canjhealthtechnol.ca/index.php/cjht/article/view/eh0103/683">amyloid-beta peptide</a> and <a href="https://nouvelles.umontreal.ca/en/article/2022/10/20/unlocking-the-mysteries-of-tauopathies-a-protein-that-gives-hope/">tau protein</a> in neurons.</p>
<p>However, in order to reach their targets, the drugs must first cross the <a href="https://www.theglobeandmail.com/canada/article-toronto-researchers-look-at-new-approach-for-treating-alzheimers/">blood-brain barrier</a> (BBB) from the blood to the brain. This is because <a href="https://www.biorxiv.org/content/10.1101/2020.12.10.419598v1.full">endothelial cells</a>, cells that line the tiniest blood vessels in the brain, regulate the exchange between blood and the brain. They maintain a balance that allows access to essential molecules such as glucose, but restrict the passage of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494002/">most pharmaceuticals</a>, including the new and <a href="https://www.ft.com/content/32478dbf-7270-4eb6-a576-663a47a3603e">much-hyped</a> drug <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2212948">lecanemab</a>.</p>
<p>When these brain endothelial cells become diseased, the balance is upset. The brain struggles to get the substances it needs back into the circulation and rejects those that might harm it.</p>
<p>The brain and the other organs of the body are thus in constant communication, while in health or in disease.</p>
<p>As experts in neurodegenerative diseases and the BBB, we have conducted a study on insulin receptor dysfunction in Alzheimer’s disease.</p>
<h2>Insulin and the brain</h2>
<p><a href="https://www.healthlinkbc.ca/health-topics/types-insulin">Insulin</a> is an essential hormone for life. It is best known for its effect on the regulation of <a href="https://www.diabetescarecommunity.ca/living-well-with-diabetes-articles/blood-sugar-levels-in-canada/?gclid=Cj0KCQiAyracBhDoARIsACGFcS4fee8N8dfBJj9HKxpUiGlNO6RANNF9BiZN52dsd6oxqgLCW7Od_WsaArF9EALw_wcB">blood sugar</a> and remains an essential part of the pharmaceutical treatment of <a href="https://www.healthlinkbc.ca/health-topics/types-insulin">diabetes</a>. In recent decades, researchers have noted vascular and metabolic abnormalities <a href="https://pubmed.ncbi.nlm.nih.gov/30022099/">in a high proportion of patients with dementia</a>.</p>
<p>Indeed, Type 2 diabetes, characterized in the later stages by <a href="http://www.diabetesclinic.ca/en/diab/1basics/insulin_resistance.htm">insulin resistance</a>, is a major risk factor for Alzheimer’s disease. There is some evidence to suggest that the <a href="https://pubmed.ncbi.nlm.nih.gov/29377010/">Alzheimer’s brain is less responsive to insulin</a>. Conversely, studies have shown that insulin can <a href="https://pubmed.ncbi.nlm.nih.gov/32730766/">improve memory</a>, prompting the development of clinical trials on the effect of insulin on Alzheimer’s disease.</p>
<p>Yet we still don’t know what cell types and mechanisms are involved in the action — and loss of action — of insulin in the brain. The vast majority of insulin is produced by the <a href="https://pancreaticcancercanada.ca/the-pancreas/">pancreas</a> and secreted into the bloodstream. Therefore, to affect the brain, insulin must first interact with the BBB and its endothelial cells, which are in contact with the blood and can take up insulin through <a href="https://pubmed.ncbi.nlm.nih.gov/36280236/">receptors</a>.</p>
<h2>Alzheimer’s and the insulin receptor</h2>
<p>In order to measure the amount of these insulin receptors in the brain, <a href="https://doi.org/10.1093/brain/awac309">we performed analyses directly in human tissues</a>. These samples came from a <a href="https://www.rushu.rush.edu/research/departmental-research/religious-orders-study">cohort</a> of over a thousand people who agreed to donate their brains after death. We have access to them through a partnership with researchers at Rush University in Chicago.</p>
<p>We found that the <a href="https://healthenews.mcgill.ca/new-insights-into-how-insulin-interacts-with-its-receptor/">insulin-binding receptor</a> is predominantly located in the microvessels, so, within the BBB itself. Moreover, the abundance of this receptor is decreased in Alzheimer’s patients. This decrease could lead to the loss of insulin response in the Alzheimer brain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="schematic" src="https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=781&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=781&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=781&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=982&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=982&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499093/original/file-20221205-15238-9izujo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=982&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The brain insulin receptor is located mainly at the BBB, and its ability to respond to blood insulin is diminished in Alzheimer’s disease.</span>
<span class="attribution"><span class="source">(Manon Leclerc)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Insulin receptor dysfunction</h2>
<p>In order to better control the experimental variables and measure the response of the insulin receptor, we then tested our hypotheses in mice. The <em>in situ</em> cerebral perfusion technique consists of injecting insulin directly into the carotid artery (an artery located in the neck) so that it reaches the brain in its entirety. We have shown that circulating insulin mainly activates receptors located on the cerebral microvessels.</p>
<p>Although it was generally accepted that insulin crosses the BBB to reach cells such as neurons deeper in the brain tissue, our results show that the proportion of insulin that crosses the BBB is low.</p>
<p>These two observations thus confirm that the majority of insulin must interact with cells in the BBB before it can exert an action on the brain.</p>
<p>We then applied the same method to <a href="https://www.criver.com/products-services/research-models-services/genetically-engineered-model-services/transgenic-mouse-rat-model-creation/transgenic-mice?region=3601">transgenic mice</a>, which were genetically modified to model Alzheimer’s disease. We found that the response to insulin at the BBB was dysfunctional, with no activation of the insulin receptor in these diseased mice.</p>
<p>Thus, in both humans and rodents, the brain insulin receptor is located primarily at the BBB, and its ability to respond to blood insulin is impaired in Alzheimer’s disease.</p>
<h2>A significant breakthrough</h2>
<p>In sum, our results suggest that alterations in the number, structure and function of insulin receptors at the level of BBB endothelial cells may contribute to the cerebral insulin resistance observed in Alzheimer’s disease.</p>
<p>Alzheimer’s research efforts are currently focused on drugs that, in order to reach their therapeutic target, the neurons, must first cross the BBB, which severely restricts their passage. By targeting the metabolic dysfunction of the brain instead, we propose a research alternative that has two major advantages.</p>
<p>The first is that we can use treatments that do not have to cross the BBB barrier, since it is the endothelial cells themselves that become the therapeutic target. The second involves <a href="https://www.nature.com/articles/nrd.2018.168">“drug repurposing,”</a> which consists of taking advantage of the phenomenal therapeutic arsenal already approved to fight diabetes and obesity, but using this in the context of Alzheimer’s.</p>
<p>It should be remembered that the few drugs available to us provide only a modest improvement in symptoms. Combating insulin resistance in the brain would make it possible to break the vicious circle between neuropathology (disease that affects the brain) and diabetes, and in theory slow down the progression of the disease.</p>
<h2>The work is not finished</h2>
<p>On the basic research side, we will continue to study the mechanisms downstream from the microvessels to understand the action of insulin on the deep layers of the brain.</p>
<p>We hope that clinical research will follow suit with human studies to repurpose drugs that target certain metabolic diseases, such as diabetes, towards fighting Alzheimer’s.</p>
<p>In the meantime, while waiting for pharmaceutical solutions, each of us would do well to adopt the preventive cocktail that we all know well: a healthy diet combined with frequent physical and mental exercise.</p><img src="https://counter.theconversation.com/content/196016/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frederic Calon has received funding from: Canadian Institutes of Health Research (CIHR), Natural Sciences and Engineering Research Council of Canada (NSERC), Fonds de la recherche du Québec en santé (FRQS), Alzheimer Society of Canada.</span></em></p><p class="fine-print"><em><span>Manon Leclerc has received scholarships from the Fondation du CHU de Québec and the Fonds de Recherche du Québec - Santé (FRQS).</span></em></p><p class="fine-print"><em><span>Vincent Emond ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Impaired insulin receptors in the blood vessels between the blood and the brain may contribute to the insulin resistance observed in Alzheimer’s disease.Frederic Calon, Professeur, Université LavalManon Leclerc, PhD student, Université LavalVincent Emond, Professionnel de recherche, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952112022-12-05T04:08:53Z2022-12-05T04:08:53ZHow long does menopause last? 5 tips for navigating uncertain times<figure><img src="https://images.theconversation.com/files/498812/original/file-20221204-8737-i0hf3d.jpg?ixlib=rb-1.1.0&rect=23%2C46%2C5145%2C3399&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-female-friends-socializing-backyard-600w-583329838.jpg">Shutterstock</a></span></figcaption></figure><p>Around half of the world’s population are women or people who menstruate – yet the way their body works can be a mystery, even to them. </p>
<p>Most women will experience periods roughly every month, many will go through childbirth and those who live into midlife will experience menopause. </p>
<p>While menopause is a significant time of change, it isn’t talked about much, other than as a punchline. This may contribute to keeping it a <a href="https://www.theguardian.com/membership/2019/sep/21/breaking-the-menopause-taboo-there-are-vital-stories-we-should-continue-to-pursue">taboo topic</a>. </p>
<p>So, what happens during menopause? How do you know when it is happening to you? And – the thing most women want to know – how long will it last? </p>
<h2>What is menopause?</h2>
<p>Menopause is <a href="https://www.nia.nih.gov/health/what-menopause">defined</a> as the permanent cessation of menstruation, which is medically determined to be one year after the final menstrual period. After this time women are considered to be postmenopausal.</p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/26598775/">average age</a> of “natural menopause” (that is not caused by a medical condition, treatment or surgery) is considered to be around 51 years. </p>
<p>However, natural menopause does not occur suddenly. <a href="https://www.researchgate.net/profile/Riitta-Luoto/publication/46425690_Prevalence_of_menopause_symptoms_and_their_association_with_lifestyle_among_Finnish_middle-aged_women/links/5c5704ac458515a4c7553c7b/Prevalence-of-menopause-symptoms-and-their-association-with-lifestyle-among-Finnish-middle-aged-women.pdf">Changes can begin</a> a number of years before periods stop and most often occur in a woman’s 40s but they can be earlier. Changes <a href="https://pubmed.ncbi.nlm.nih.gov/25686030/">can continue</a> for 10 years or more after periods have stopped. </p>
<p>Using hormones such as the oral contraceptive pill or hormone intrauterine devices may make it more <a href="https://pubmed.ncbi.nlm.nih.gov/31934948/">difficult to determine</a> when changes start.</p>
<p>Menopause that occurs <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">before 45</a> is called “early menopause”, while menopause before 40 is called “premature menopause”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1592079966384009216"}"></div></p>
<h2>What about perimenopause?</h2>
<p>Various <a href="https://www.menopause.org.au/hp/information-sheets/glossary-of-terms">terms</a> are used to describe this period of change, including “menopause” or “the menopause”, “menopausal transition”, “perimenopause” or “<a href="https://pubmed.ncbi.nlm.nih.gov/12188398/">climacteric</a>”. </p>
<p>These terms tend to refer to the period before and after the final menstrual period, when changes are considered to be related to menopause. </p>
<p>The difficulty with the definition of menopause is it can only be decided retrospectively. Yet women can experience changes many years before their periods stop (a lead up usually called “perimenopause”). Also, any <a href="https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0889854518300627/first-page-pdf">changes noticed</a> may not be associated with menopause (because people might not be aware of what to expect) or changes may be associated with a combination of factors such as stress, being busy or other health issues.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">'Brain fog' during menopause is real – it can disrupt women's work and spark dementia fears</a>
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<h2>So, what is going on?</h2>
<p>Through a feminist lens, menopause can be seen as a <a href="https://www.researchgate.net/publication/354652248_The_volcano_within_a_study_of_women's_lived_experience_of_the_journey_through_natural_menopause">complex and diverse experience</a>, influenced by biological, psychological, social and cultural aspects of women’s lives. </p>
<p>However, it is usually viewed from the biomedical perspective. This sees it as a biological event, marked by the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">decline</a> in ovarian hormone levels leading to a reduction in reproductive function. </p>
<p>The female reproductive system operates because of a finely tuned balance of hormones managed by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466056/#:%7E:text=The%20hypothalamic%2Dpituitary%2Dovarian%20(HPO)%20axis%20must%20be,priming%20the%20endometrium%20for%20implantation.">hypothalamic-pituitary-ovarian axis</a>. International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/">experts</a> have developed a staging system for female reproductive ageing, with seven stages from “early reproductive” years to “late postmenopause”. </p>
<p>However, female reproductive hormones do not just affect the reproductive system but <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">other aspects</a> of the body’s function. These include the <a href="https://pubmed.ncbi.nlm.nih.gov/26007613/">neurological system</a>, which is linked to hot flushes and night sweats and disrupted sleep. Hormones may also affect the <a href="https://www.nature.com/articles/nrdp20154">heart and body’s blood circulation</a>, bone health and potentially the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">immune system</a>. </p>
<p>Menopausal hormone changes may <a href="https://www.thewomens.org.au/health-information/menopause-information/menopause-symptoms/">cause</a> hot flushes, night/cold sweats, mood swings, sleep disruption and tiredness, vaginal dryness.</p>
<p>Medical confirmation of menopausal changes in women over 45 years is based on two biological indicators: vasomotor symptoms (those hot flushes and night sweats again) and an <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">irregular menstrual cycle</a>. </p>
<p>In early perimenopause the changes to the menstrual cycle may be subtle. Women may not recognise early indicators, unless they keep a record and know what to watch for.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman writing something at outdoor table" src="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498609/original/file-20221202-21-d268zz.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>
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<span class="caption">Keeping track of any changes that could be menopausal is a good idea.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/1251832/pexels-photo-1251832.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-perimenopause-and-how-does-it-affect-womens-health-in-midlife-122186">What is perimenopause and how does it affect women's health in midlife?</a>
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<h2>How long does it last?</h2>
<p>The body demonstrates an amazing ability to change over a lifetime. In a similar way to adolescence where long-lasting changes occur, the outcome of menopause is also change. </p>
<p>Research suggests it is difficult to give an exact time frame for how long menopausal changes occur – the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">average</a> is between four and eight years. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">Penn Ovarian Ageing Study</a> found 79% of the 259 participants experienced hot flushes starting before the age of 50, most commonly between 45 and 49 years of age. </p>
<p>A later report on the same study found one third of women studied experienced <a href="https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0014-2">moderate to severe hot flushes</a> more than ten years after their periods had stopped. A <a href="https://journals.lww.com/menopausejournal/Abstract/2017/03000/Cultural_issues_in_menopause__an_exploratory.11.aspx">2017 study</a> found a small number of women continued to experience hot flushes and other symptoms into their 70s. </p>
<p>So overall, the research cannot offer a specific window for perimenopause, and menopause does not appear to mark the end of changes for everyone. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person holds phone with period tracking app and menstrual cup" src="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498612/original/file-20221202-26-sk1as7.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>
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<span class="caption">Menopause is ‘official’ once you haven’t had periods for one year.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-woman-calculating-menstrual-600w-2151967283.jpg">Shutterstock</a></span>
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<strong>
Read more:
<a href="https://theconversation.com/making-sense-of-menopausal-hormone-therapy-means-understanding-the-benefits-as-well-as-the-risks-124084">Making sense of menopausal hormone therapy means understanding the benefits as well as the risks</a>
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<h2>5 tips for uncertain times</h2>
<p>Shifts and changes can be recognised early by developing knowledge, paying attention to changes to our bodies and talking about menopause and perimenopause more openly.</p>
<p>Here are five tips for moving from uncertainty to certainty: </p>
<p><strong>1.</strong> talk to people and find out as much information as you can. The experiences of mothers and sisters may help, for some women there are familial similarities </p>
<p><strong>2.</strong> notice any changes to your body and make a note of them, this will help you recognise changes earlier. There are <a href="https://www.redonline.co.uk/wellbeing/a36980118/menopause-apps/">menopause tracking apps</a> available</p>
<p><strong>3.</strong> keep a note of your menstrual cycle: start date, duration, flow and note any changes. Again, an app might help</p>
<p><strong>4.</strong> if you are worried, seek advice from a GP or nurse that specialises in women’s health. They may suggest ways to help with symptoms or refer to a specialist </p>
<p><strong>5.</strong> remember changes are the indicator to pay attention to, not time or your age.</p>
<p>Menopause is a natural process and although we have focused here on the time frame and “symptoms”, it can also be a time of freedom (particularly from periods!), reflection and a time to focus on yourself.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/lhosPUwWhfI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Women speak about their experiences of menopause.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/195211/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yvonne Middlewick 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>Uncertainty about how long symptoms will last can be tough for women going through hormonal changes that come with menopause. Unfortunately, there isn’t a clear cut time frame.Yvonne Middlewick, Nurse & Lecturer, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1956632022-12-02T12:17:07Z2022-12-02T12:17:07ZHailey Bieber has revealed she has an ovarian cyst – here’s why they happen<figure><img src="https://images.theconversation.com/files/498658/original/file-20221202-20-5xa2de.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5670%2C3774&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ovarian cysts often go away on their own.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cannes-france-may-12-hailey-baldwin-1120930493">Andrea Raffin/ Shutterstock</a></span></figcaption></figure><p>Model Hailey Bieber <a href="https://uk.style.yahoo.com/hailey-bieber-reveals-she-cyst-121800176.html?">recently revealed</a> that she’s been suffering with an <a href="https://www.nhs.uk/conditions/ovarian-cyst/">ovarian cyst</a> the size of an apple. </p>
<p>While we don’t know exactly how many women suffer with ovarian cysts, they are thought to be relatively common – with estimates suggesting around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039362/">7% of women</a> will suffer from an ovarian cyst at some point in their life.</p>
<p>But these numbers could be even higher, as not all cysts present symptoms. For example, based on data from CT scans, it’s believed that between <a href="https://pubs.rsna.org/doi/full/10.1148/radiol.2017162139">6%</a>-<a href="https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/ovarian-cysts/">18%</a> of premenopausal women have a cyst that they don’t even know about.</p>
<p>There are two main types of ovarian cysts: <a href="https://www.ncbi.nlm.nih.gov/books/NBK560541/">simple and complex</a>. Both grow on or inside one or both ovaries. Simple cysts are filled with fluid, while complex cysts often contain other substances – such as blood or cells. Complex cysts are rarer, but are associated with an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/">increased risk</a> of cancer. These can vary in size, with guidelines suggesting they can be up to <a href="https://www.rcog.org.uk/media/yhujmdvr/gtg_62-1.pdf">5cm in diameter</a> without symptoms or need for treatment. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735515/">Giant cysts</a>, which measure more than 10cm in diameter, can also happen.</p>
<p>While some cysts go away on their own after two to three menstrual cycles, others may need to be surgically removed.</p>
<p>Ovarian cyst <a href="https://www.nhs.uk/conditions/ovarian-cyst/">symptoms vary</a> from person to person but typically include pelvic pain – which can also vary in intensity, from dull pain to sudden, sharp pain which gets worse during the period. Cysts can also cause frequent urination, difficulty emptying the bowels, as well as discomfort or pain during sex. It can also change the menstrual cycle alongside menstrual flow.</p>
<h2>Why cysts happen</h2>
<p>As part of the normal menstrual cycle every month, a follicle (a cyst-like structure) develops on one of the ovaries. This is where the egg will develop. The follicle also <a href="https://www.frontiersin.org/articles/10.3389/fphys.2021.730196/full">produces hormones</a> that prepare the uterus for implantation, if the egg is fertilised by a sperm. Once the egg is mature, the follicle releases the egg into the ovarian tube – a process known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK441996/">ovulation</a>. But in some instances, this release of the egg fails and the follicle/cyst persists and may continue to grow. </p>
<p>There are a number of factors that can increase the likelihood an ovarian cyst. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934082/">Fertility treatment</a>, for example, can cause a woman’s ovaries to develop more follicles at once, increasing the potential for cysts. Surprisingly, <a href="https://www.ncbi.nlm.nih.gov/books/NBK549873/">getting your tubes tied</a> is also associated with an <a href="https://pubmed.ncbi.nlm.nih.gov/12907096/">increased risk</a> of developing ovarian cysts. But taking the oral contraceptive pill, which prevents ovulation, actually decreases the likelihood of ovarian cysts.</p>
<p><a href="https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism">Hypothyroidism</a> can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965274/">hyper-stimulate the ovaries</a>, which may have a <a href="https://link.springer.com/article/10.1007/s13193-020-01263-8">similar effect</a> as fertility treatment in that it causes more eggs to be produced. These may turn into cysts if they’re not released. </p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1751721422001105">Pregnancy</a> can also increase the chances of ovarian cysts. Certain hormones peak during the second trimester and these can lead to an increase in the presence of cysts. It’s also <a href="https://www.sciencedirect.com/science/article/abs/pii/S1751721422001105">potentially more likely</a> that cysts will be identified during pregnancy because of routine ultrasounds. </p>
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<img alt="A woman holds her stomach in pain." src="https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498659/original/file-20221202-19-j7t8fr.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">Ovarian cysts can cause a sharp, shooting pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-front-stomach-painful-sign-ovarian-1640559202">mady70/ Shutterstock</a></span>
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<p>Smoking is another factor that may <a href="https://academic.oup.com/aje/article/161/6/520/80886">increase the likelihood of developing ovarian cysts</a>. Studies have shown that smoking <a href="https://pubmed.ncbi.nlm.nih.gov/7862381/">alters hormones</a> linked to the <a href="https://pubmed.ncbi.nlm.nih.gov/9916957/">menstrual</a> <a href="https://www.ncbi.nlm.nih.gov/books/NBK535442/">cycle</a>.</p>
<p>And finally, the condition <a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/">polycystic ovary syndrome</a> can also result in women developing multiple cysts in their ovaries. But the diagnosis for this condition and treatment is different to ovarian cysts. </p>
<h2>Treating ovarian cysts</h2>
<p>Cysts typically remedy themselves and do not need any treatment. However, large cysts on the ovary can cause <a href="https://www.ncbi.nlm.nih.gov/books/NBK560675/">ovarian torsion</a>, where the weight of the cyst causes it to pull the ovary down in the pelvis, twisting the fallopian tube and cutting off the blood supply to the ovary and surrounding tissues. </p>
<p>Having an ovarian cyst is the biggest risk factor for ovarian torsion. So, if a cyst is of substantial size or causing symptoms, surgery may need to be performed to remove the cyst. This is done by making <a href="https://www.frontiersin.org/articles/10.3389/fsurg.2020.00024/full">small incisions</a> in the body wall, near the belly button.</p>
<p>If the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061010/">cyst is too big</a> or there are complications, it may be necessary to remove the entire ovary.</p>
<p>But before treatment can happen, doctors will need to determine whether symptoms are caused by ovarian cysts. Many other conditions – some of which can be life threatening – can present in very similar ways. </p>
<p>For instance, endometriosis can cause symptoms that also appear similar to ovarian cysts. However, endometriosis pain is <a href="https://www.frontiersin.org/articles/10.3389/fncel.2020.590823/full">usually chronic</a>, and typically becomes worse with a person’s period – whereas cyst pain can come on suddenly and severely. Though endometriosis can also cause cysts, these are known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK559230/">endometriomas</a> (chocolate cysts), which are filled with menstrual blood. </p>
<p><a href="https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/03/tubal-ectopic-pregnancy">Tubal pregnancy</a>, the most common type of <a href="https://fertilityresearchandpractice.biomedcentral.com/articles/10.1186/s40738-015-0008-z">ectopic pregnancy</a> is another example. This is when the fertilised egg implants into somewhere that is not the uterus, such as the fallopian tube. Early in a tubal pregnancy, it can cause similar pain symptoms to ovarian cysts. Doctors may need to administer a pregnancy test or ultrasound to determine whether symptoms are caused by cysts or not. </p>
<p>While ovarian cysts typically go away on their own, there are some instances where they become so large that they’re life threatening. For example, a woman in New York needed to have a <a href="https://nypost.com/2017/03/20/woman-has-70-pound-cyst-removed-from-her-ovaries/">32kg (70lb) cyst removed</a> after it began to crush her lungs and put a huge strain on her heart. Similarly, in India a woman had a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740039/">23kg cyst removed</a>. Both of these combined don’t come close to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862319/">148kg cyst</a> that was removed from a woman in 1905 and contained 40 gallons of fluid that took seven days to drain. </p>
<p>Thankfully these huge cysts and the problems they bring with them are very unlikely to happen these days as we have much better ways of detecting these kind of abnormalities before they cause harm.</p><img src="https://counter.theconversation.com/content/195663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society. </span></em></p>Model Hailey Bieber recently shared on social media that she’s suffering with an ovarian cyst the size of an apple.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944282022-11-16T13:31:31Z2022-11-16T13:31:31ZAgeing: hormone could help predict men’s long-term health years in advance – new study<figure><img src="https://images.theconversation.com/files/495612/original/file-20221116-20-s91scs.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7935%2C5020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who is likely to develop age-related disease could be predicted years in advance by looking at INSL3.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fulllength-photo-happy-senior-man-headphones-2040514991">Evgeny Atamanenko/ Shutterstock</a></span></figcaption></figure><p>We all age, but we don’t all age the same way. For some people, ageing means an increased risk of developing illnesses such as diabetes, cardiovascular disease, weak bones and cognitive decline.</p>
<p>It would be ideal if we could predict in early adulthood, while a person is still healthy, whether or not they are at risk of becoming ill or needing medical support when they are older. By then taking preventative measures, this would mean fewer people with health issues, fewer people in care, and considerably lower costs for the health system.</p>
<p>Our <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.1016107/full">latest study</a> suggests that predicting long-term health outcomes may be possible. We have found a novel insulin-like hormone in the blood, called insulin-like peptide 3 (INSL3), that may be able to predict long-term health, and whether a person is likely to develop age-related diseases – at least for men. </p>
<p>To conduct our study, we looked at data from one of the largest cohorts of ageing men, the <a href="https://academic.oup.com/ije/article/42/2/391/733095">European Male Ageing Study</a>. This had recruited 3,369 men between the ages of 40 and 79 from across Europe, including the UK, and followed them for four-to-five years. It was designed in part to assess whether the incidence of age-related disease in men can be explained by the decline of anabolic hormones such as testosterone, which is important for growth and development in the body. </p>
<p>Using data from the European Male Ageing Study, we looked for significant associations between INSL3 levels in stored blood samples that were taken at the beginning and end of the study, and the incidence of self-reported age-related illness. INSL3 was measured using a new testing method developed in our laboratory. We compared these results with the effects of other hormones such as testosterone, and also adjusted them for age, smoking status, and clinical parameters like obesity.</p>
<h2>Strong associations</h2>
<p>We were able to show that INSL3 levels can vary markedly from one person to another, and they were strongly associated with the incidence of illnesses such as cardiovascular disease, diabetes, loss of sexual function and bone weakness.</p>
<p>Men who had high INSL3 had lower risk of later becoming ill, while men with low INSL3 had a higher risk of developing age-related disease. Importantly, by looking at blood samples taken at both the beginning and end of the study, we showed that this relationship could be predicted several years in advance. </p>
<p>Although INSL3 is made in men exclusively by the same cells in the testes that make testosterone, the latter is highly variable. Testosterone levels can change markedly from hour to hour and day to day. This high variation makes it difficult to find statistically significant associations with other factors such as disease incidence. </p>
<p>Unlike testosterone, INSL3 levels remain amazingly consistent in a man’s bloodstream over long periods of time. This makes it possible to obtain similar values even when measured weeks, months or years apart. This allowed us to determine that low INSL3 was significantly linked with higher risk of age-related illness. </p>
<figure class="align-center ">
<img alt="Three young men walking together on a beach." src="https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Differences in INSL3 levels appear to emerge in men as young as 18.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/summer-holidays-vacation-happy-people-concept-192589262">Ground Picture/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In fact, <a href="https://doi.org/10.1111/andr.13001">previous research</a> from our group has shown that person-to-person variations in INSL3 levels can be seen in apparently healthy men as young as 18. Based on our findings, it seems that INSL3 levels remain similar throughout a man’s life. This means that we may be able to look at a man’s INSL3 levels when they are young and predict how likely they are to develop certain diseases when they get older.</p>
<p>It’s likely that INSL3 has functions in its own right, acting on different organs in the body. This will need to be confirmed by further research. What is clear is that the consistency of INSL3 throughout life makes it a much easier biomarker to observe when predicting age-related disease in men.</p>
<h2><strong>What’s behind these variations?</strong></h2>
<p>Our group in Nottingham is now focused on finding out what factors influence INSL3 levels in young men, and hence their capacity to make testosterone that could affect their later health.</p>
<p>Preliminary work from animal studies suggests that early-life nutrition may play a role, but many other factors including genetics or exposure to certain environmental factors (such as smoking) may also be involved. We need to confirm the predictive ability of INSL3 by studying men over a much longer period of time.</p>
<p>Of course, this work only relates to ageing men whose testes can function consistently into old age, only gradually declining in terms of sperm and hormone production. A woman’s physiology is much more radically modulated by ovarian function, which changes dramatically after the menopause. Hence we do not yet know of an equivalent to INSL3 for women when it comes to predicting ageing and disease.</p><img src="https://counter.theconversation.com/content/194428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ravinder Anand-Ivell received funding from University of Nottingham and DFG.</span></em></p><p class="fine-print"><em><span>Richard Ivell received funding for part of this study from the German Research Council (DFG) .</span></em></p>Our study found that low levels of INSL3 hormone were associated with greater risk of cardiovascular disease, diabetes and frailty in men.Ravinder Anand-Ivell, Associate Professor of Endocrinology and Reproductive Physiology, University of NottinghamRichard Ivell, Professor of Molecular Biology and Endocrinology, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874612022-08-23T20:04:10Z2022-08-23T20:04:10ZTaking the pill may change your behaviour – but exactly how is still uncertain<figure><img src="https://images.theconversation.com/files/480499/original/file-20220823-12-3y940v.jpg?ixlib=rb-1.1.0&rect=14%2C14%2C3204%2C2268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/fgqLiOKNjU8">Reproductive Health Supplies Coalition / Unsplash</a></span></figcaption></figure><p>The first hormonal contraceptive (the “pill”) was approved by the US Food and Drug Administration in 1960. Hormonal contraceptives have since become one of the most prescribed drugs in the world, used daily by more than <a href="https://doi.org/10.1016/j.beem.2012.11.004">100 million people worldwide</a>. </p>
<p>These drugs prevent pregnancy by delivering synthetic hormones into the bloodstream. Synthetic hormones stop the body’s own hormones from stimulating ovulation, so no eggs are released, no fertilisation can occur, and pregnancy is prevented. </p>
<p>Research has shown naturally occurring hormones have a <a href="https://psycnet.apa.org/record/2016-41420-012">strong influence on behaviour</a> in humans and other animals. But less is known about the behavioural effects of synthetic hormones – like those in the pill. </p>
<p>Some of the hormones affected by the pill are linked to competitive behaviour. We wanted to find out more about how hormonal contraceptives change this behaviour, so <a href="https://authors.elsevier.com/a/1fRnfKmdqWd3-">we reviewed</a> all the research we could find about hormonal contraceptives and competitive behaviour. </p>
<h2>Hormones and competition</h2>
<p>Competition is part of life. We compete for a variety of resources, such as money, food, mates and allies, to fulfil our needs and improve our chances of survival and flourishing.</p>
<p>These resources may also be intangible things, such as social status, that give us access to more direct goods. A high-status individual may have better opportunities for education and jobs, for example. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-convincing-evidence-the-pill-can-cause-depression-and-some-types-are-worse-than-others-184248">There's convincing evidence the pill can cause depression, and some types are worse than others</a>
</strong>
</em>
</p>
<hr>
<p>Hormonal contraceptives directly affect three hormones that have been linked to competitive behaviour: <a href="https://www.sciencedirect.com/science/article/pii/S0018506X15301537">testosterene</a>, <a href="https://psyarxiv.com/vn8zu/">progesterone</a>, and a type of estrogen called <a href="https://pubmed.ncbi.nlm.nih.gov/17949722/">estradiol</a>.</p>
<p>To understand the role of hormonal contraceptives on competition, we reviewed 46 studies, with a total of 16,290 participants. This was all the available published research that included a measure of competition.</p>
<h2>Status and motivation</h2>
<p>One finding from our review was that hormonal contraceptives may have an impact on women’s motivation and ability to achieve higher status. </p>
<p>One study shows an effect of lower <a href="https://www.sciencedirect.com/science/article/abs/pii/S0091302222000383">achievement motivation</a>. </p>
<p>Another study shows lower performance on <a href="https://www.sciencedirect.com/science/article/abs/pii/S0018506X19304726">tasks requiring persistence</a>. This is concerning because people often achieve higher status by demonstrating skill or mastery. </p>
<h2>Mating choices</h2>
<p>The pill may also affect competition around mating. Recent research shows naturally cycling women feel more <a href="https://psycnet.apa.org/doi/10.1037/pspp0000251">sexually desirable</a> and <a href="https://www.cambridge.org/core/journals/evolutionary-human-sciences/article/women-feel-more-attractive-before-ovulation-evidence-from-a-largescale-online-diary-study/1E25337DA0BD0AECFA976F7A736AF6B4">attractive</a> mid-cycle, but hormonal contraceptive users do not. </p>
<p>This suggests hormonal contraceptives diminish a fertility-induced increase in feelings of desirability that likely motivate sexual behaviour.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/freer-sex-and-family-planning-a-short-history-of-the-contraceptive-pill-92282">Freer sex and family planning: a short history of the contraceptive pill</a>
</strong>
</em>
</p>
<hr>
<p>We did not find robust evidence that hormonal contraceptive users differ from non-users in the type of men they are attracted to. There was also a lack of evidence that users behave differently when competing for financial resources compared to non-users.</p>
<p>Interestingly, the effect of hormonal contraceptives on mating and status-based competitiveness depended on the participants’ relationship status. For example, <a href="https://doi.org/10.1016/j.evolhumbehav.2013.04.003">one study</a> revealed that hormonal contraceptive use diminished self-reported competitiveness for women in relationships but not single women. </p>
<p>This could mean synthetic hormones influence single and partnered women differently. On the other hand, it could also mean single and partnered women have other differences that influence these behaviours. </p>
<h2>Small effect sizes and methodological limitations</h2>
<p>It’s important to note that the behavioural differences between those who use hormonal contraceptives and those who don’t were generally quite small.</p>
<p>Another discovery from our review was that much of the existing research on the effect of hormonal contraceptives is plagued by important methodological limitations. </p>
<p>Only <a href="https://pubsonline.informs.org/doi/10.1287/mnsc.2017.2844">one of the studies</a> we reviewed used <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235704/">randomised controlled trials</a>, the gold standard for determining the effect of a particular drug or treatment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
</strong>
</em>
</p>
<hr>
<p>Many studies we reviewed also did not account for other differences between hormonal contraceptive users and non-users, such as age. These are factors that could explain behaviour differences independent of hormones and hormonal contraceptives.</p>
<p>The small sample sizes in much of the research make it difficult to generalise to a wider population. Non-white women in particular were largely underrepresented in this research. </p>
<p>Many of the studies also did not report the types of hormonal contraceptives that people were using. This makes it impossible to determine whether all types of contraceptives are associated with similar outcomes.</p>
<p>Because of these limitations, the findings in our review are only preliminary.</p>
<h2>Where to from here?</h2>
<p>Despite 60 years of widespread use, the effects of hormonal contraceptives are still poorly understood. They are also used for <a href="https://www.guttmacher.org/report/beyond-birth-control-overlooked-benefits-oral-contraceptive-pills">many purposes</a> other than birth control, such as to reduce premenstrual symptoms, resolve hormone imbalances, or lessen the symptoms of acne and endometriosis.</p>
<p>Access to reliable contraception has huge benefits for individuals and society. It is associated with increased female participation in <a href="https://dash.harvard.edu/bitstream/handle/1/2624453/Goldin_PowerPill.pdf?sequence=4">higher education</a>, a smaller <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684076/">gender gap in wages</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/24988652/">reduced female poverty</a>. </p>
<p>To ensure women can make informed decisions about their own bodies, we need reliable and robust evidence about the full effects of hormonal contraceptives. To paraphrase American filmmaker <a href="https://www.nytimes.com/2018/01/09/opinion/birth-control-your-own-adventure.html">Sindha Agha</a>, we have the right to birth control, but we also have the right to better birth control. It’s going to take a lot more research.</p><img src="https://counter.theconversation.com/content/187461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Khandis R Blake receives funding from the Australian Research Council (DE210100800 & DP220101023).</span></em></p><p class="fine-print"><em><span>Kathleen Casto and Lindsie Arthur 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>Research shows hormonal contraceptives may have small but significant effects on behaviour.Lindsie Arthur, PhD Candidate, Melbourne School of Psychological Sciences, The University of MelbourneKathleen Casto, Assistant Professor of Psychology, New College of FloridaKhandis R Blake, Lecturer in Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1833672022-07-25T20:02:00Z2022-07-25T20:02:00ZWhat to expect when coming off the pill, and 5 things to do before you do<figure><img src="https://images.theconversation.com/files/471783/original/file-20220630-15-dvkid7.png?ixlib=rb-1.1.0&rect=0%2C5%2C3528%2C2359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Unsplash/Drew Dizzy Graham</span></span></figcaption></figure><p>“The pill” (the combined oral contraceptive pill) has been giving Australian women control over their reproductive health since the 1960s and remains the <a href="https://www.ogmagazine.org.au/16/2-16/combined-oral-contraceptives/">most commonly used</a> method of contraception by Australian women. </p>
<p><a href="https://alswh.org.au/shorthand/reproductive-health-report/#group-section-The-Pill-QkSUaAOLBq">Its use peaks</a> with around 60% of Australian women in their late teens and early 20s using the pill, and drops to around 35% by the mid to late 20s. </p>
<p>Used perfectly, the pill <a href="https://shvic.org.au/for-you/contraception/daily-contraceptive-pills/contraceptive-pill">prevents pregnancy</a> 99.5% of the time, but in the real world where pills are occasionally forgotten it works 93% of the time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-effective-is-the-pill-122189">How effective is the pill?</a>
</strong>
</em>
</p>
<hr>
<p>In Australia, half of the women who start on the pill won’t be taking it <a href="https://alswh.org.au/shorthand/reproductive-health-report/#group-section-The-Pill-QkSUaAOLBq">six months later</a>. Women come off the pill for lots of different reasons, including:</p>
<ul>
<li><p>trying to fall pregnant</p></li>
<li><p>trying a different contraceptive option</p></li>
<li><p><a href="https://www.bmj.com/content/bmj/3/5773/495.full.pdf">side effects</a> (including headaches, bloating, weight gain, not having a regular period, unpredictable nuisance or “breakthrough” bleeding, nausea, depression, reduced libido)</p></li>
<li><p>developing a medical condition where the pill is no longer safe (the most common of these is migraine or deep vein thrombosis, or smoking over the age of 35)</p></li>
<li><p>no longer needing contraception </p></li>
<li><p>wanting to know what their natural cycle and periods are like. </p></li>
</ul>
<p>If you’re preparing to come off the pill, it’s hard to know what to expect – particularly if you’ve been on it for a long time.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-convincing-evidence-the-pill-can-cause-depression-and-some-types-are-worse-than-others-184248">There's convincing evidence the pill can cause depression, and some types are worse than others</a>
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</em>
</p>
<hr>
<h2>What may happen when you come off the pill</h2>
<p>Regardless of how long you’ve been taking the pill, the synthetic hormones are cleared from the body within days. Your body returns to releasing different amounts of oestrogen and progesterone throughout the cycle – although what’s “normal” for your body may have changed. </p>
<p>Teenagers can have irregular periods for the first few years before a more regular rhythm establishes. A lot might have changed since you first went on the pill – your body could have developed a medical condition, have a different lifestyle, changed size or shape, or had children. This can all impact how natural hormones in your body can impact you. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman looking off into sunset" src="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471790/original/file-20220630-26-g8oyc7.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">Regardless of how long you’ve been taking the pill, the synthetic hormones are cleared from the body within days.</span>
<span class="attribution"><span class="source">Unsplash/artem kovalev</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Here are some of the changes you might expect when coming off the pill.</p>
<p><strong>Periods!</strong> </p>
<p>For many women, <a href="https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use">periods come back within a month</a> of stopping the pill, with almost all women getting their period within three months. Your periods may start off irregular, but generally return to the natural menstrual cycle within three months. Women on the pill often have quite light periods, so coming off the pill you might experience heavier or longer periods. The natural cycle can also be impacted by exercise, diet, stress and underlying medical conditions. It’s a good idea to see a doctor if you haven’t got your period back within three months.</p>
<p><strong>Fertility</strong> </p>
<p>Women can expect their <a href="https://www.bmj.com/content/371/bmj.m3966">fertility to return to their baseline</a> “natural” level around three cycles after coming off the pill. That being said, you can definitely get pregnant as soon as you come off the pill. Being on the pill does not impact long-term fertility, even if it was taken for many years, so there’s no medical need to take a “break” from the pill to “normalise” things for the body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-women-dont-need-to-take-a-break-from-the-pill-every-couple-of-years-87940">No, women don't need to 'take a break' from the pill every couple of years</a>
</strong>
</em>
</p>
<hr>
<p><strong>Underlying medical issues</strong> </p>
<p>For some women, coming off the pill can reveal problems the pill has been masking. For women with endometriosis, the pill commonly reduces their symptoms of painful periods, cramping, heavy bleeding and painful sex - and suppresses growth of the endometrial tissue in areas other than inside the uterus, where it belongs. Coming off the pill can cause a ramping up in period and pelvic pain. For women with a history of polycystic ovarian syndrome, periods are likely to return to being irregular once coming off the pill.</p>
<p><strong>Acne</strong> </p>
<p>For women who experience hormonally driven acne (commonly seen around the jawline and which fluctuates with the period cycle), acne can flare after coming off the pill. Getting older or lifestyle changes can impact this though, so it’s not a given acne will return.</p>
<p><strong>Mental health</strong> </p>
<p>There is <a href="https://www.nps.org.au/australian-prescriber/articles/hormonal-contraception-and-mood-disorders">growing evidence</a> the hormones in the pill can bring on or worsen depression for some women, and is one of the <a href="https://www.bmj.com/content/bmj/3/5773/495.full.pdf">most common reasons</a> for stopping the pill. However, for women who experience depressive symptoms in the week leading up to their period (a condition known as premenstrual dysphoric disorder) taking the pill stabilises the mood and <a href="https://www.nps.org.au/australian-prescriber/articles/hormonal-contraception-and-mood-disorders">works as an antidepressant</a>. It goes without saying then that women coming off the pill can see changes to their mood or anxiety levels, and it’s good to keep your mental health care provider in the loop.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
</strong>
</em>
</p>
<hr>
<h2>5 things to do before coming off the pill</h2>
<ul>
<li>talk to your GP or other health professionals beforehand, particularly if you have had heavy periods, painful periods or other issues in the past. If you’re not happy with your particular type of pill, know there are other options for contraception including other contraceptive pills which may not cause the same side effects</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman against a wall closing her eyes and smiling" src="https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=373&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=373&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=373&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=469&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=469&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471792/original/file-20220630-13-dvkid7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=469&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you’re not happy with your particular type of pill, know there are other options for contraception.</span>
<span class="attribution"><span class="source">Unsplash/Prince Akashi</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<ul>
<li><p>have a plan for alternative contraception if you’re likely to be at risk of pregnancy and want to avoid it. If you have a regular partner, you might wish to have a conversation with them and discuss other options</p></li>
<li><p>consider monitoring and writing down your cycle and symptoms (heaviness and painfulness of periods, mood and anxiety) for 2–3 months before coming off the pill and afterwards. This can help you and your doctor recognise if coming off the pill uncovers some unexpected issues. Seek medical advice early if you are having heavy or painful periods</p></li>
<li><p>try to choose a time when life isn’t too stressful or chaotic, if possible. This will help you to work out if your symptoms are related to hormones, life in general - or both!</p></li>
<li><p>if you’re coming off the pill to prepare to conceive, it’s a good opportunity to book in for a prenatal check up. This can include talking about preparing yourself physically and mentally, supplements, and doing some blood tests to check for immunity against some viruses.</p></li>
</ul><img src="https://counter.theconversation.com/content/183367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phoebe Holdenson Kimura 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>If you’re preparing to come off the pill, it’s hard to know what to expect, particularly if you’ve been on it for a long time.Phoebe Holdenson Kimura, Lecturer and GP, University of SydneyLicensed as Creative Commons – attribution, no derivatives.