Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.
The review is timely, as March is Endometriosis Awareness Month.
Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.
“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.
Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging.
“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.
“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.
Every woman experiences cramps at some point in her life. For some, it’s mild discomfort, while for others, it can be debilitating. The pain often makes it hard for them to get through the day, let alone participate in activities they enjoy.
In addition, many women also find that their moods are affected by cramps, making them more irritable and prone to anxiety or depression.
Cramps are caused by the uterus contracting to shed the uterine lining. This process is called menstruation or a period that is integral to women’s sexual and reproductive health. The contractions can be quite strong, and they can cause pain in the lower abdomen, back, and thighs. Aside from that, symptoms may include nausea, vomiting, diarrhea, fatigue, and cramps.
While there are several ways to ease the pain of cramps, such as taking over-the-counter medication and using a heating pad, some women are looking for more natural solutions. If you’re one of them, yoga and meditation may be worth a try.
YOGA AND MEDITATION POSES
Yoga is a low-impact form of exercise that relieves all sorts of pain, including menstrual cramps. It involves stretching and holding certain positions for a period of time to relax the muscles and ease the pain.
On the other hand, meditation is a form of mindfulness that allows you to focus on your breath and be in the present moment to help you take your mind off the pain you are feeling and relax.
There are several different yoga and meditation poses that can help to ease period cramps. Some of the most effective ones are listed below:
Child’s Pose
The child’s pose is excellent for stretching out your lower back and relieving pain in your spine. It also helps to relax the muscles in your hips, thighs, and calves.
To do this pose, start on your hands and knees with your palms flat on the ground and your knees hip-width apart. As you exhale, bow forward, lowering your forehead to the ground. Then, allow your hips to sink back towards your heels and your arms to extend out in front of you. Hold this position for at least 30 seconds to a minute.
Modified Cobra Pose
For your breathing and relaxation, try this modified version of Cobra Pose. It can help to open up your chest and shoulders while strengthening your back.
To get into the pose, lie on your stomach with your legs straight out behind you and your palms flat on the ground next to your shoulders. As you inhale, lift your chest off the ground, keeping your pelvis and thighs firmly planted. Stay in this position for a few seconds before slowly lowering back to the ground.
Pelvic Tilts
Pelvic Tilts is an excellent exercise if you’re feeling bloated or constipated. It’s a gentle way to massage the internal organs and improve circulation in your lower body. Plus, it’s a great technique to burn calories during your period.
Start by lying on your back with your knees bent and your feet flat on the ground. As you exhale, press down into your feet and tilt your pelvis toward the sky. Take a few seconds to keep this position before going back to the starting position. Repeat ten times.
Supported Bridge Pose
Another great pose for getting rid of period cramps is the Supported Bridge Pose. This pose eases the pain by opening up the chest and shoulders to relieve the tension built up in these areas during your period.
For this pose, you’ll need a yoga block and a blanket. Then, lay on your back with your knees bent and your feet flat on the ground. Place the yoga block under your lower back, and put the blanket over your pelvis. As you inhale, press your feet into the ground and lift your hips off of the ground. Hold this pose for 30 seconds to a minute, then release it back to the ground.
Cat-Cow Pose
If you’re feeling nauseous or have headaches in addition to your cramps, the Cat-Cow pose can help, as it stretches out your back and neck muscles.
First, put your hands and knees on the ground with your palms flat and your knees hip-width apart. Then, as you inhale, arch your back and look up towards the ceiling. Then, as you exhale, round your back and tuck your chin towards your chest. Repeat this sequence ten times.
MEDITATION TIPS
Besides these yoga poses, meditation can be a helpful tool for managing period cramps. Here are a few tips to get started:
1. Focus on your breath: One of the simplest ways to meditate is to focus on your breath. First, find a comfortable position to sit or lie in and close your eyes. Then, focus on taking deep, slow breaths. For instance, inhale through your nose for a count of four, then exhale through your mouth for a count of eight. Repeat this for 5-10 minutes.
2. Count your breaths: Another way to focus on your breath is to count each inhale and exhale. Begin by inhaling for a count of four, then exhaling for a count of eight. On the next inhale, count to three, then exhale for a count of eight. Continue counting down on the inhales until you reach one. Then, start back at four and repeat the cycle.
3. Focus on a mantra: A mantra is a short, repeated phrase or word that can help to focus and calm the mind. Choose a mantra that is simple and easy to remember. Once you have chosen your mantra, repeat it aloud or silently to yourself as you breathe. For example, you could repeat the word “relax” or “let go” with each inhale and exhale.
4. Visualize a peaceful scene: Another way to calm the mind is to visualize a peaceful scene. Close your eyes and imagine yourself in a calming place like a beach or meadow. Then, focus on the details of the scene-the sounds, smells, and colors. Stay in this peaceful place for 5 minutes or longer.
Conclusion
While there’s no one-size-fits-all solution for managing period cramps, yoga and meditation can be helpful for many people. If you’re new to these practices, start with simple poses and meditations. Then, as you become more comfortable, you can try more advanced techniques.
Lastly, remember to listen to your body and stop if you feel any pain. With regular practice, you’ll likely find relief from your cramps.
With plant-based diets now being linked to reduced menopausal symptoms, nutrition experts Free Soul have analysed the most unexpected ways that going vegan could support women experiencing menopause.
Key
Findings:
Doctors are claiming that treating menopause as a hormone deficiency and over-medicalising the condition can increase anxiety and stress in women.
Recent research also found that negative expectations of menopause increased the likelihood of women experiencing distressing symptoms.
Over 75% of menopausal women report their symptoms, with almost a quarter describing them as severe and although many women achieve reduced symptoms from hormone therapy, changing diet and regular exercise can also relieve symptoms.
Six key medical organisations, including the British Menopause Society and Royal College of Obstetricians and Gynecologists, have drawn up 11 new standards for menopause care which focus on lifestyle advice and dietary modification.
Adopting a plant-based, soy-rich diet has been proven to reduce moderate-to-severe hot flushes in menopause by 84%.
A recent study has uncovered that menopausal women who followed a vegan diet with no other restrictions lost more weight at a higher rate overall than those following a low-fat restricted diet.
How
Severe are Menopausal Symptoms?
It’s no
secret that menopause is not a chapter that many women look forward to in their
lives. Menopausal symptoms last for an average duration of 7 years, with 1 in 3 women experiencing symptoms beyond this
time. This time in a woman’s life impacts individuals in different ways,
however common symptoms of menopause and perimenopause include
hot flushes, anxiety, fatigue, poor sleep or insomnia and weight gain.
Long-term,
more concerning health issues related to menopause can include
reduced libido, osteoporosis, heart disease and even dementia as a result of
lowered oestrogen levels.
What
are the Experts Saying?
When it comes
to managing symptoms and providing sufficient support to women experiencing
menopause, six key medical organisations, including the British Menopause Society and Royal College of Obstetricians and
Gynecologists, have drawn up 11 new standards for menopause care.
Within the
new standards is a call for a “holistic and individualised approach” in
assessing and advising women with particular reference to lifestyle advice and
dietary modification. These 2022 standards suggest that the UK’s main
authorities on menopause and peri-menopause are acknowledging the importance of
diet as a tool to manage menopause symptoms. Additionally, the British Dietetic Association highlight that a range of lifestyle
changes can reduce the severity of symptoms and whilst hormone replacement
therapy (HRT) can be used to help many women control symptoms, some cannot take
the treatment due to health issues and others simply choose not to. They
outline diet and taking the correct dietary
supplements as key
factors that can help women to reduce their symptoms.
Ingredients
in dietary supplements specifically targeted to menopause and perimenopause,
such as Free Soul’s Peri-Menopause Advanced Support, have been proven to
effectively relieve symptoms. For instance, multiple studies have demonstrated that isoflavone,
found in many menopause and perimenopause supplements, effectively reduces hot
flushes, reduces lumbar spine bone mineral density loss and improves glycaemic
control.
In terms of diet, adopting a plant-based, soy-rich diet
has been proven reduce moderate-to-severe hot flushes
in menopause by 84% according to a recent study. During the 12-week study, nearly 60% of women became
totally free of moderate-to-severe hot flushes, demonstrating the undeniable
power of choosing to go vegan during menopause.
5 Ways
That Going Vegan Could Help with Managing Menopause Symptoms
Minimising
Hot Flushes
Night sweats
and hot flushes, also known as vasomotor symptoms, impact 80% of women during menopause. However, adopting a
vegan diet can dramatically reduce these symptoms, with the Women’s Study for the Alleviation of
Vasomotor Symptoms revealing
that a combination of a strict plant-based diet combined with half a cup of
soybeans each day resulted in moderate-to-severe hot flushes being reduced from
nearly five per day to fewer than one per day. Overall hot flushes, including
mild ones, also decreased by 79%, emphasising the undeniable fact that a vegan,
soy-rich diet Is the way to go when it comes to controlling those dreaded hot
flushes and night sweats.
Maintaining
a Healthy Weight
Often during
menopause, women experience weight gain due to declining oestrogen levels, age-related
loss of muscle tissue and lifestyle factors such as diet. This internal body
fat, also known as visceral fat, whilst unproblematic for many, can encourage insulin
resistance and lead to health issues such as type 2 diabetes. Therefore, during
menopause, it’s important to opt for a balanced diet including wholefoods,
fruits and vegetables.
A recent study has uncovered that menopausal women who
followed a vegan diet with no other restrictions lost more weight at a higher
rate overall than those following a low-fat restricted diet, indicating that a
balanced vegan diet could help to support a healthier lifestyle for those concerned
with weight gain during menopause. When managed correctly, a vegan diet promotes weight loss, reduces the
risk of heart disease by lowering cholesterol, lowers the chance of getting
certain cancers such as colon cancer and manages diabetes by lowering AC1
levels.
As with any
diet however, sensible choices must be made and important nutrients must be
incorporated. Protein-rich foods such as tofu, edamame, soy, chickpeas lentils
and nutritional yeast should always be included in a vegan diet, with vegan
protein powder also a popular choice for supplementing protein intake. It’s
also important to maintain vitamin B12 levels, which can be found in fortified
cereals and rice to promote muscle repair and energy. Essential fatty acids
from greens and whole grains, iron and vitamin D to boost cognitive function
and mood.
Quality of Sleep
Unfortunately,
sleep disorders plague 39-47% of perimenopausal women and 35-60% of
postmenopausal women, with the most common issues being hot flushes, insomnia
and sleep-disordered breathing according to Sleep Foundation. Not only has the power of plant-based
diets been proven to mitigate hot flushes to a large extent, but vegan diets
may also lead to increased levels of the amino acid
tryptophan which can
lead to increased melatonin and serotonin, thus enhancing sleep quality and
quantity. Tryptophan can be found in kale, bananas, mushrooms, peas and
almonds, all of which can be easily integrated into your vegan diet and can
support a great night’s sleep.
Alleviating
Anxiety
It seems that
a staggering number of women suffer mental health symptoms as a result of
menopause; a 2020 study conducted in Brazil uncovered that
58% of women aged 45–55 who were experiencing perimenopause had anxiety
symptoms. In the same study, 62% experienced symptoms of depression.
Interestingly,
the brain doesn’t use the amino acid tryptophan to support good sleep alone; it
also uses it to provide feelings of happiness and positive mental well-being
through serotonin production. In fact, those with a vegan diet reported less
stress and anxiety than omnivores in a
study investigating the
effects of both diets on mood.
To encourage
ideal levels of tryptophan and reduce anxiety during menopause, your vegan diet must include a combination of plant
proteins along with complex carbohydrates such as fruit, vegetables, whole
grains and legumes according to the Physician’s Committee for Responsible
Medicine.
Healthier
Hair and Skin
Due to
reduced oestrogen production, hair can start to thin and many women can also
experience drier skin. Luckily the magic of a plant-based diet also extends to
improved health for both the skin and hair.
Naturally,
when done correctly, a plant-based diet should increase your intake of whole
foods and reduce your intake of harmful processed foods that can negatively
impact health. However, when it comes to hair health, a study has shown that a
plant-based diet can help to reduce the risk of androgenetic alopecia, proving that going vegan can prevent hair loss to an
extent. In addition, a vegan diet is far more likely to promote a healthy scalp
and in turn create a healthy environment for hair follicles to flourish.
When it comes to maintaining skin health, a recent narrative review of 20 studies on plant-based foods shows that the
beneficial effects on skin include improvement in hydration, wrinkles, and elasticity.
Using soy extract and drinking soy beverages
(equivalent to 15 grams to 25 grams of soy protein per day) can also boost skin
hydration during menopause and beyond. It is therefore clear that capitalising on the
incredible benefits of these foods as part of a balanced vegan diet rich in
fruit and vegetables could help to counteract the effects of menopause such as
dry skin.
From improved
sleep hygiene to reduced hot flushes and anxiety, it is evident that the vegan
diet offers feasible natural alternatives to managing symptoms of menopause.
With experts now calling for a more holistic and individualised approach to
assessing menopause care, now may be the time that more light is shed on the indisputable
power of nutrition and a balanced, active lifestyle. Lucy Murray, Vegan
Lifestyle Expert at Free Soul, comments:
“There are a
whole host of benefits associated with a vegan diet and so many of them can
help to support women during the menopausal period. When done in the form of a
balanced mix of foods, a plant-based diet can provide the appropriate amounts
of protein, essential fatty acids and vitamins to support women going through
menopause, with supplements such as our vegan protein powder for women great for helping achieve
the right nutritional balance.”
Daily life movement includes all activity done while moving on one’s feet during activities such as housework, gardening, cooking and self-care activities. CREDIT Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego
Seniors take note, running or brisk walking is not the only way to reduce the risk of heart disease. Simply being “up and about” performing routine activities, referred to as daily life movement, including housework, gardening, cooking and self-care activities like showering can significantly benefit cardiovascular health.
Compared to women with less than two hours per day of daily life movement, those women with at least four hours of daily life movement had a 43% lower risk of cardiovascular disease, 43% lower risk of coronary heart disease, 30% lower risk of stroke and notably, a 62% lower risk of cardiovascular disease death.
Reporting in the Feb. 22, 2022 online edition of the Journal of the American Heart Association, a multi-institutional team led by researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego studied the impact of daily life movement to cardiovascular disease risk.
“The study demonstrates that all movement counts towards disease prevention,” said first author first author Steve Nguyen, Ph.D., M.P.H., postdoctoral scholar at the Herbert Wertheim School of Public Health. “Spending more time in daily life movement, which includes a wide range of activities we all do while on our feet and out of our chairs, resulted in a lower risk of cardiovascular disease.”
Researchers used a machine-learning algorithm to classify each minute spent while awake into one of five behaviors: sitting, sitting in a vehicle, standing still, daily life movement, or walking or running. Daily life movement encompasses activities occurring when standing and walking within a room or patio, such as when getting dressed, preparing meals or gardening.
As part of the Women’s Health Initiative Objective Physical Activity and Cardiovascular Health study, researchers measured the physical activity of nearly 5,416 American women, who were aged 63 to 97 and who did not have heart disease at the start of the study.
Participants wore a research-grade accelerometer for up to seven days to get accurate measures of how much time they spent moving and, importantly, the types of common daily life behaviors that result in movement and are not often included in prior studies of light and moderate-to-vigorous intensity physical activity. Those prior studies typically focused on intensity and duration of activities like running and brisk walking while the current study measured smaller movements at varying intensity during activities like cooking.
Cardiovascular disease continues to be the leading cause of death among both women and men in the United States with rates highest in adults aged 65 or older.
In this study, 616 women were diagnosed with cardiovascular disease, 268 with coronary heart disease, 253 had a stroke, and 331 died of cardiovascular disease.
“Much of the movement engaged in by older adults is associated with daily life tasks, but it may not be considered physical activity. Understanding the benefits of daily life movement and adding this to physical activity guidelines may encourage more movement,” said senior author Andrea LaCroix, Ph.D., M.P.H., Distinguished Professor and chief of the Division of Epidemiology at the Herbert Wertheim School of Public Health.
Endometriosis is 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 Aragona, GP and Online
Doctor for PrescriptionDoctor.com 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
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