Women’s Health

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What is Endometriosis? Here’s everything you need to know


This week is  Endometriosis awareness week, it’s the unseen and therefore often misdiagnosed disease that only affects women. The chronic condition can have an impact on both emotional wellbeing and physical health, yet so many still don’t fully understand what it is, its symptoms or the full extent of the condition.

Here, Dr Giuseppe, GP and Medical Advisor at Prescription Doctor, a UK based online pharmacy and doctor service providing customers with a safe, convenient and discreet way of accessing treatments, provides answers to 7 key questions surrounding the condition. The answers should provide some clarity, help aid awareness and highlight the challenges those face whose lives have been affected by the condition.

 What actually is Endometriosis?

Endometriosis is a long-term condition, which only affects women, whereby tissue (a bit like the lining of the womb) begins to develop and grow in other places in the body such as the fallopian tubes and the ovaries. We know that each month, as part of natural hormonal changes, a woman’s tissue lining in her womb builds and then breaks down. When no egg has been fertilised, the tissue lining exits the woman’s body as a period, but for women living with endometriosis, its slightly different and not quite as straightforward. When the tissue breaks down during the hormonal change in a woman living with endometriosis, it is unable to exit the body so the blood stores inside the body – making it very painful for some women.

How does it develop?

Firstly, you can’t catch it, and you can’t pass it on.  Although there are several theories on hormones, genetics and the way women menstruate; there is no known singular cause. Whilst the condition does tend to run in families, its not been exclusively proven and its likely that a combination of multiple elements cause the condition.

What are the symptoms?

As with any condition, there are some typical symptoms of endometriosis however it is really important to note that symptoms can vary from women to women. You may have a friend or family member who has been diagnosed with endometriosis but their symptoms are completely different. Some women have no noticeable symptoms and the condition appears ‘hidden’ whilst other women may have severe symptoms both physically and mentally. For some women, unfortunately, endometriosis can be linked with a low mood and feelings of depression; this is because the condition can have a detrimental impact on day-to-day life.

The main symptoms of endometriosis are:

  • Period pain; women with endometriosis are more likely to have painful periods and this can be anywhere from mild pain to excruciating pain meaning that they aren’t able to do normal day to day activities;
  • Pelvic pain; usually in the lower abdomen or the lower back.
  • Heavy or irregular periods;
  • Nausea, diarrhoea or constipation;
  • Pain during sex;
  • Difficulty when trying to get pregnant or infertility (not all women with endometriosis will have fertility problems and not all women will need treatment to get pregnant).

Who does it affect? 

Endometriosis affects 1 in 10 women in the UK. Endometriosis is a chronic and detrimental disease, impacting women (and girls) of childbearing age, and it is estimated that around 1.5 million women in the UK are currently living with the condition. 

How can you manage it? 

Although there is no cure for endometriosis, there are so many treatments for women and these can help with the symptoms of the condition.  Depending on the symptoms you have, your circumstances and the severity of both the symptoms and the disease, will affect what treatments are available for you.

How can you treat it?

If your symptoms are mild, there may be no need for treatment and you may find that your symptoms get better on their own.

Some treatments will focus on relieving the pain such as painkillers which may supress some of the symptoms. Other women will be prescribed hormone medicines and different contraceptive treatments to help manage the condition by trying to control the level or stopping the production of oestrogen in their body.

A symptom and complication of endometriosis is the difficulty women may be faced with when trying to get pregnant. There are treatments available to help improve the chances of conceiving and slow the growth of the endometriosis tissue such as surgery to remove the tissue during a laparoscopy. The surgeon will be able to destroy parts of the affected tissue with a laser.

Whilst every effort can be made to treat the condition, the outcome may be to have surgery to remove all or part of the areas that are affected by the endometriosis tissue. This can, in some cases, mean that surgery may be required to remove the womb, also known as a hysterectomy. This is an option that your GP or gynaecologist will discuss with you depending on your circumstances.

When should you visit your GP? 

We’ve mentioned that endometriosis can often be misdiagnosed especially because of the difference in symptom levels and many other conditions may cause similar symptoms. It is however really important to see a GP if you think you have symptoms of endometriosis.

Some general advice would be to write down your symptoms before your appointment, this is because the GP may decide to examine the pelvic area and whilst symptoms can get better by themselves, equally, left untreated, the condition may worsen. 

Your GP will be able to advise you if they suspect there is a possibility that you do have endometriosis and they may refer you to a gynaecologist to test for the condition. The only way to be certain whether you do have endometriosis will be from the test results, following either an internal or external ultrasound scan and a laparoscopy. The gynaecologist will be able to discuss your options for treatment depending on the results of your tests.

This piece has been brought to you by Prescription Doctor

https://www.prescriptiondoctor.com/

For more information please contact Helen@helenkathleen.co.uk

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Worldwide Views on Menstruation – What Can You Expect?


In the UK, there have been many prolific movements aimed at normalising periods for women of all ages. This has even stretched to the addition of a period emoji to smartphones, after a public vote by Plan International UK in 2017. However, the most popular choice (a pair of pants marked by blood) was rejected by the regulatory group Unicode Consortium.

While periods are an inevitable aspect of life for most women, the experience of menstruation isn’t universal. In fact, it can differ notably depending on factors such as geography and cultural beliefs.

So, does this signify that we are only scratching the surface when it comes to tackling the menstrual taboo? We’re taking a menstrual tour around the world, looking at the perception of periods and how this can affect a girl’s understanding of their own cycle.

Afghanistan

In Afghanistan, girls are wary of getting their first period and the way in which they manage their flow is determined by cultural and economic factors. Period management products are accessible in the UK, but in Afghanistan, one sanitary towel can cost the equivalent of £3.24 and this simply isn’t feasible for many women. The inability to access period pads leads to women improvising. 62% of Afghani schoolgirls have been found to tear strips of their clothing and use these to manage their flow.

There’s an array of period taboos which women are told to live by too. These include not drinking hot water, not sitting on wet ground and not washing during a period. Generally, a sense of shame and secrecy is distilled into girls when they get their period, leading them to wash their used cloth strips at night to keep them out of sight.

This attests to the overall lack of education on the topic of periods. In some of the strictest, most conservative regions of the country, science teachers are told not to cover the topic of puberty at all.

Various charities are targeting the poor sanitation and misinformation on menstruation, and awareness within the country is also growing — menstrual hygiene management classes were introduced at Mehri Herawi High School in Herat, moving towards reshaping girls’ beliefs about their own periods.

Bolivia

Girls in Bolivia have a similar experience and periods have been historically hushed and dismissed based on cultural beliefs and tradition. In fact, one of the most prolific myths is that menstrual blood is dangerous and could cause diseases such as cancer if it is mixed in with general rubbish. This has resulted in girls carrying around used sanitary towels in their school bags. This isn’t the only menstrual myth in Bolivia. Some women believe eating mayonnaise could help shorten the length of a period!

Furthermore, in the advertisement of sanitary products, big brands use words like ‘dirty’ and ‘stain’ in their branding, portraying a negative image of menstruation.

Attitudes towards periods are changing in Bolivia though. UNICEF has been working with rural communities in the country helping to invalidate these myths through education. The charity has also led an increased focus on improving school bathroom facilities, providing products such as non-applicator tampons and sanitary waste bins. Furthermore, some of the country’s ancient beliefs celebrate menstruation and they are being taught to young women to help reshape understandings of the menstrual cycle. [CH1] 

India

Many women in the western world can access sanitary products readily and must manage the aches and pains that come as a result of periods. However, for women in India, menstruation is treated as a physical burden. In small Indian villages, some women are made to leave their village and go to a gaokor — a small, basic hut where girls must spend the duration of their period. There’s no kitchen in a gaokor, as women are forbidden from cooking while on their periods. While here, they’re open to all the elements, making it a difficult experience — endured simply because they are menstruating. This ritual is prevalent among groups such as Gond and Madiya communities, and it is representative of the extent to which period education is lacking. A shocking 23% of girls drop out of school when they start menstruating, showing how damaging these attitudes can be.

The country is also known for preventing menstruating women from entering certain religious sites and temples. This is rooted in the belief that periods are impure. This policy has come under fire through, targeted by movements such as #HappyToBleed, initiated by Nikita Azad. The campaign was triggered by a comment from the chief of the Sabarimala temple, after a court ruling established that women aged between 10-50 (typically menstruating age) could enter the holy site. The movement encouraged women of all ages to take to social media and spread awareness of the need for India to modernise its stance on menstruation. The call for change has spread across all media and a recent documentary titled Period. End of Sentence gave women across the country the opportunity to discuss their menstrual health, tackling the shame which is associated with periods.

Picking up sanitary essentials such as tampons seems so ordinary to the Western world that it’s hard to imagine a situation where others are stigmatised for doing so, or don’t even have access to such products. However, as we’ve discovered, there are charities and movements calling for worldwide period equality – let’s hope their messages get through. [CH2] 

Sources:

https://www.independent.co.uk/voices/period-emoji-unicode-menstruation-iphone-android-poverty-stigma-a8772166.html

https://inews.co.uk/news/technology/blood-droplet-period-emoji-period-pants-stigma-shame-126210

https://undark.org/article/afghanistan-menstruation-taboo/

https://www.unicef.org/afghanistan/stories/busting-myths-and-breaking-taboos

http://www.bolivianexpress.org/blog/posts/menstruation-its-myths-and-removing-its-shame

https://khoobsurati.com/why-girls-arent-allowed-in-the-temples-during-periods.htmlhttps://www.independent.co.uk/news/world/asia/indian-women-launch-happy-to-bleed-campaign-to-protest-against-sexist-religious-rule-a6748396.html

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Acupressure for menstrual pain- Women benefit from self-care app




Menstrual cramps

Menstrual cramps

 




Can acupressure achieve a sustained reduction in menstrual pain? Is an app-based self-care program particularly attractive to young women? These questions addressed in a new study by researchers from Charité – Universitätsmedizin Berlin, the results of which have been published in the American Journal of Obstetrics and Gynecology*.

Approximately 50 to 90 percent of young women experience pain during their periods. While this pain primarily manifests itself as lower abdominal cramping, other symptoms include headache, backache, nausea and diarrhea. Acupressure is a technique derived from traditional Chinese medicine (TCM). In contrast to acupuncture, this technique can be used as a form of self-care and is suitable for use at home. Rather than using needles, this technique involves massage or pressure being applied to specific points on the body.

The researchers wanted to evaluate whether in a group of women suffering from severe menstrual pain, aged between 18 and 34, self-acupressure would be more effective at achieving a sustained reduction in menstrual pain than usual care alone (e.g. pain medication and hormonal contraceptives). A total of 221 participants were randomly assigned to one of two treatment groups, both of which received a study app and short introduction. Acupressure-based features – with instructions on how to administer self-acupressure shortly before and during menstruation – were only made available to the intervention group. One advantage of an app-based intervention is its ability to provide visual descriptions of the pressure points users need to target in order to achieve the desired effect. It can also send regular reminders. Additionally, the app was used to collect all study-related data.




“Initially, we simply wanted to conduct a study on the use of self-care techniques for menstrual pain. However, the women who were involved during the planning stages, all of whom were affected by menstrual pain, wanted an app,” reports the study’s principal investigator, Prof. Dr. Claudia Witt of the Institute of Social Medicine, Epidemiology and Health Economics. The app helped participants to apply simple self-acupressure techniques to three different acupressure points.

After three months, 37 percent of participants in the acupressure group reported a 50 percent reduction in pain intensity. After six months, this proportion had increased to more than half of the women in this group (58 percent). Only 25 percent of women in the control group reported a similar reduction in pain intensity at both the 3-month and 6-month marks. Women in the acupressure group also used less pain medication than women in the control group and reported lower levels of pain overall.

“We were surprised to see that, after six months, two thirds of participants continued to use self-acupressure. So far, research into the clinical effectiveness of apps has been limited, and only a few have been tested using randomized controlled trials,” says Dr. Daniel Pach of the Institute of Social Medicine, Epidemiology and Health Economics. He adds: “We were able to show that apps can be evaluated in a clinical trial setting. However, despite our experience with conventional clinical trials, there was a lot for us to learn – something we found both exciting and eye-opening.” The app Luna has recently been updated and optimized for use with iOS.

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WHO study shows drug could save thousands of women’s lives

Baby and Mother

Baby and Mother

A new formulation of a drug to prevent excessive bleeding following childbirth could save thousands of women’s lives in low- and lower-middle-income countries, according to a study led by the World Health Organization (WHO) in collaboration with MSD for Mothers and Ferring Pharmaceuticals.

Currently WHO recommends oxytocin as the first-choice drug for preventing excessive bleeding after childbirth. Oxytocin, however, must be stored and transported at 2–8 degrees Celsius, which is hard to do, in many countries, depriving many women of access to this lifesaving drug. When they can obtain it, the drug may be less effective because of heat exposure.

The study, published today in the New England Journal of Medicine, has shown an alternative drug – heat-stable carbetocin – to be as safe and effective as oxytocin in preventing postpartum haemorrhage. This new formulation of carbetocin does not require refrigeration and retains its efficacy for at least 3 years stored at 30 degrees Celsius and 75% relative humidity.

“This is a truly encouraging new development that can revolutionize our ability to keep mothers and babies alive,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

Approximately 70 000 women die every year because of post-partum haemorrhage – increasing the risk that their babies also die within one month.

The clinical trial, the largest of its kind, studied close to 30 000 women who gave birth vaginally in 10 countries: Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom.

Each woman was randomly given a single injection of either heat-stable carbetocin or oxytocin immediately following the birth of her baby. The study found that both drugs were equally effective at preventing excessive bleeding after birth.

Since both drugs in the study were kept in at the temperatures required to ensure maximum efficacy of oxytocin, the trial may underestimate the benefit expected with heat-stable carbetocin use in real-life settings where oxytocin may have degraded due to exposure to higher temperatures.

“The development of a drug to prevent postpartum haemorrhage that continues to remain effective in hot and humid conditions is very good news for the millions of women who give birth in parts of the world without access to reliable refrigeration,” says Dr Metin Gülmezoglu, from the Department of Reproductive Health and Research at WHO.

The next step is regulatory review and approval by countries.

WHO will ask its Guideline Development Group to consider whether heat-stable carbetocin should be a recommended drug for the prevention of postpartum haemorrhage.

About the study
This WHO study, also referred to as the CHAMPION (Carbetocin HAeMorrhage PreventION) trial, was funded by MSD for Mothers. Heat-stable carbetocin was provided by Ferring Pharmaceuticals, the product innovator and oxytocin was provided by Novartis for the study. The study was conducted under a collaborative arrangement between WHO, MSD for Mothers and Ferring Pharmaceuticals. Following the positive results from the trial, the parties will now work to advance affordable access to this lifesaving drug in countries that have a high burden of maternal deaths.

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Healthy eating during the menopause




A healthy diet for the menopause

A healthy diet for the menopause




Eating a healthy, balanced diet and losing any excess weight can help ease some of the symptoms of the menopause, such as tiredness and hot flushes, and reduce your risk of heart and bone problems.

It’s important to eat a wide variety of foods, in the right amounts and proportions, to get to and maintain a healthy body weight. Following the Eatwell Guide can help you achieve this.

Include foods that are good for the bones

After going through the menopause, your bones will begin to lose density. This can make them weaker over time, so it is important to make sure you’re getting enough calcium and vitamin D, which are vital for bone health.

Calcium

Sources of calcium include:

dairy foods, such as milk, cheese and yoghurt (lower-fat versions have the same amount of calcium)

soya products with added calcium

leafy green vegetables (but not spinach)

some nuts and seeds, including almonds, brazil nuts and sesame seeds

bread and anything made with fortified flour

fish where you eat the bones, such as tinned sardines

Vitamin D

Sources of vitamin D include:

sunlight (during spring and summer only)

oily fish (for example, salmon, mackerel, herring, sardines or pilchards)

egg yolks and red meat

liver

products with added vitamin D, such as fortified breakfast cereals

During autumn and winter, you should think about taking a daily vitamin D supplement to make sure you’re getting enough. You can buy these from pharmacies or most large supermarkets.

If you’re concerned about your vitamin D levels, you can speak to your GP about having a blood test to check them. In some cases, you may be prescribed a higher-dose vitamin D supplement.

Read more about bone health during the menopause.

Aim for at least 5 portions of fruit and veg a day

Fruit and vegetables are a vital source of vitamins and minerals. It’s advised that we eat at least 5 portions each day.




Evidence shows that people who eat at least 5 A Day have a lower risk of heart disease, stroke and some cancers. Surveys have shown that most women aged 50 to 64 eat less than this.

Getting your 5 A Day isn’t as hard as it sounds:

having a sliced banana with your morning cereal is a quick way to get the first portion

swap your mid-morning biscuit for a large slice of pineapple or melon, or 5 cherry tomatoes, for your second portion

add a side salad to your lunch for your third portion

have 3 heaped tablespoons of cooked vegetables or pulses with dinner to get your fourth

snack on an apple, pear or 2 tangerines in the evening to get your fifth portion

Read more about what counts towards your 5 A Day.

Base your meals on starchy foods

Starchy foods should make up just over a third of our diet.

Potatoes, for example, are a great source of starch as well as fibre. Leave the skins on where possible to get more of fibre.

Try to choose wholegrain or wholemeal varieties of starchy foods, such as brown rice, wholewheat pasta and wholemeal bread. They contain more fibre, and usually more vitamins and minerals than white varieties.

Read more about starchy foods.

Why protein is important

Protein plays a vital role in helping the body recover from illness and infections.

Fish is good source of protein, and also contains many vitamins and minerals. Oily fish, such as salmon, mackerel and sardines, are rich in omega-3 fatty acids.

You should aim to eat at least 2 portions of fish a week, including 1 portion of oily fish. It can be fresh, frozen or canned, but remember that canned and smoked fish can often be high in salt. Choose varieties sold in oil rather than brine.

Meat is another good source of protein. It’s also one of the main dietary sources of vitamin B12, and rich in other vitamins and minerals.

Pick lean cuts of meat and skinless poultry whenever possible to reduce fat. Also, use healthier cooking methods – for example, grilling and steaming rather than frying.

Learn more about meat in your diet.

Eggs, pulses, beans, nuts and tofu are also great sources of protein. Plain, unsalted nuts are high in fibre and protein, but they also contain a lot of unsaturated fats. This means they’re high in calories, so eat them in moderation.

Learn more about eggs in your diet.

Cut down on fats, sugar and salt

Having some fat in your diet is essential, but too much saturated fat can raise the amount of cholesterol in your blood, increasing your risk of developing heart disease. This is why it’s important to get most of your fat from small amounts of unsaturated oils and spreads.

Too much salt in your diet can raise your blood pressure, which increases your risk of heart disease and stroke.

Regularly consuming food and drink that’s high in sugar increases your risk of obesity and tooth decay.

Find out more about cutting down on the amount of saturated fat, salt and sugar in your diet.

For more information on how to eat well and maintain a healthy weight, read our 8 tips for healthy eating and check out our healthy recipes section.