What you need to know about endometriosis

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Endometriosis affects one in 10 people with a uterus who are of reproductive age. This condition occurs when tissue similar to the endometrium—the inner lining of the uterus—grows on organs outside of the uterus, causing severe pain that impacts patients’ quality of life.

Read on to learn more about endometriosis: What it is, how it’s diagnosed and treated, where patients can find support, and more.

What is endometriosis, and what areas of the body can it affect?

The endometrium is the tissue that lines the inside of the uterus and sheds during each menstrual cycle. Endometriosis occurs when endometrial-like tissue grows outside of the uterus.

This tissue can typically grow in the pelvic region and may affect the outside of the uterus, fallopian tubes, ovaries, vagina, bladder, intestines, and rectum. It has also been observed outside of the pelvis on the lungs, spleen, liver, and brain.

What are the symptoms?

Symptoms may include pelvic pain and cramping before or during menstrual periods, heavy menstrual bleeding, bleeding or spotting between periods, pain with bowel movements or urination, pain during or after sex or orgasm, fatigue, nausea, bloating, and infertility.

The pain associated with this condition has been linked to depression, anxiety, and eating disorders. A meta-analysis published in 2019 found that more than two-thirds of patients with endometriosis report psychological stress due to their symptoms.

Who is at risk?

Endometriosis most commonly occurs in people with a uterus between the ages of 25 and 40, but it can also affect pre-pubescent and post-menopausal people. In rare cases, it has been documented in cisgender men.

Scientists still don’t know what causes the endometrial-like tissue to grow, but research shows that people with a family history of endometriosis are at a higher risk of developing the condition. Other risk factors include early menstruation, short menstrual cycles, high estrogen, low body mass, and starting menopause at an older age.

There is no known way to prevent endometriosis.

How does endometriosis affect fertility?

Up to 50 percent of people with endometriosis may struggle to get pregnant. Adhesions and scarring on the fallopian tubes and ovaries as well as changes in hormones and egg quality can contribute to infertility.

Additionally, when patients with this condition are able to conceive, they may face an increased risk of pregnancy complications and adverse pregnancy outcomes.

Treating endometriosis, taking fertility medications, and using assistive reproductive technology like in vitro fertilization can improve fertility outcomes.

How is endometriosis diagnosed, and what challenges do patients face when seeking a diagnosis?

A doctor may perform a pelvic exam and request an ultrasound or MRI. These exams and tests help identify cysts or other unusual tissue that may indicate endometriosis.

Endometriosis can only be confirmed through a surgical laparoscopy (although less-invasive diagnostic tests are currently in development). During the procedure, a surgeon makes a small cut in the patient’s abdomen and inserts a thin scope to check for endometrial-like tissue outside of the uterus. The surgeon may take a biopsy, or a small sample, and send it to a lab.

It takes an average of 10 years for patients to be properly diagnosed with endometriosis. A 2023 U.K. study found that stigma around menstrual health, the normalization of menstrual pain, and a lack of medical training about the condition contribute to delayed diagnoses. Patients also report that health care providers dismiss their pain and attribute their symptoms to psychological factors.

Additionally, endometriosis has typically been studied among white, cisgender populations. Data on the prevalence of endometriosis among people of color and transgender people is limited, so patients in those communities face additional barriers to care.

What treatment options are available?

Treatment for endometriosis depends on its severity. Management options include:

  • Over-the-counter pain medication to alleviate pelvic pain
  • Hormonal birth control to facilitate lighter, less painful periods
  • Hormonal medications such as gonadotropin-releasing hormone (GnRH) or danazol, which stop the production of hormones that cause menstruation
  • Progestin therapy, which may stop the growth of endometriosis tissue
  • Aromatase inhibitors, which reduce estrogen

In some cases, a doctor may perform a laparoscopic surgery to remove endometrial-like tissue.

Depending on the severity of the patient’s symptoms and scar tissue, some doctors may also recommend a hysterectomy, or the removal of the uterus, to alleviate symptoms. Doctors may also recommend removing the patient’s ovaries, inducing early menopause to potentially improve pain.

Where can people living with endometriosis find support?

Given the documented mental health impacts of endometriosis, patients with this condition may benefit from therapy, as well as support from others living with the same symptoms. Some peer support organizations include:

For more information, talk to your health care provider.

This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Good (Or Bad) Health Starts With Your Blood

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    Blood Should Be Only Slightly Thicker Than Water

    This is Dr. Casey Means, a physician, lecturer (mostly at Stanford), and CMO of a metabolic health company, Levels, as well as being Associate Editor of the International Journal of Diabetes Reversal and Prevention, where she serves alongside such names as Dr. Colin Campbell, Dr. Joel Fuhrman, Dr. Michael Greger, Dr. William Li, Dr. Dean Ornish, and you get the idea: it’s a star-studded cast.

    What does she want us to know?

    The big blood problem:

    ❝We’re spending 3.8 trillion dollars a year on healthcare costs in the U.S., and the reality is that people are getting sicker, fatter, and more depressed.

    Over 50% of Americans have pre-diabetes or type 2 diabetes; it’s insane, that number should be close to zero.❞

    ~ Dr. Casey Means

    Indeed, pre-diabetes and especially type 2 diabetes should be very avoidable in any wealthy nation.

    Unfortunately, the kind of diet that avoids it tends to rely on having at least 2/3 of the following:

    • Money
    • Time
    • Knowledge

    For example:

    • if you have money and time, you can buy lots of fresh ingredients without undue worry, and take the time to carefully prep and cook them
    • if you have money and knowledge you can have someone else shop and cook for you, or at least get meal kits delivered
    • if you have time and knowledge, you can actually eat very healthily on a shoestring budget

    If you have all three, then the world’s your oyster mushroom steak sautéed in extra virgin olive oil with garlic and cracked black pepper served on a bed of Swiss chard and lashed with Balsamic vinegar.

    However, many Americans aren’t in the happy position of having at least 2/3, and a not-insignificant portion of the population don’t even have 1/3.

    As an aside: there is a food scientist and chef who’s made it her mission to educate people about food that’s cheap, easy, and healthy:

    Where Nutrition Meets Habits…

    …but today is about Dr. Means, so, what does she suggest?

    Know thyself thy blood sugars

    Dr. Means argues (reasonably; this is well-backed up by general scientific consensus) that much of human disease stems from the diabetes and pre-diabetes that she mentioned above, and so we should focus on that most of all.

    Our blood sugar levels being unhealthy will swiftly lead to other metabolic disorders:

    Heart disease and non-alcoholic fatty liver disease are perhaps first in line, but waiting in the wings are inflammation-mediated autoimmune disorders, and even dementia, because neuroinflammation is at least as bad as inflammation anywhere else, arguably worse, and our brain can only be as healthy as the blood that feeds it and takes things that shouldn’t be there away.

    Indeed,

    ❝Alzheimer’s dementia is now being called type 3 diabetes because it’s so related to blood sugar❞

    ~ Dr. Casey Means

    …which sounds like a bold claim, but it’s true, even if the name is not “official” yet, it’s well-established in professional circulation:

    ❝We conclude that the term “type 3 diabetes” accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both T1DM and T2DM❞

    ~ Dr. Suzanne M. de la Monte & Dr. Jack Wands

    Read in full: Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed ← this is from the very respectable Journal of Diabetes Science and Technology.

    What to do about it

    Dr. Means suggests we avoid the “glucose roller-coaster” that most Americans are on, meaning dramatic sugar spikes, or to put it in sciencese: high glycemic variability.

    This leads to inflammation, oxidative stress, glycation (where sugar sticks to proteins and DNA), and metabolic dysfunction. Then there’s the flipside: reactive hypoglycemia, a result of a rapid drop in blood sugar after a spike, can cause anxiety, fatigue, weakness/trembling, brain fog, and of course cravings. And so the cycle repeats.

    But it doesn’t have to!

    By taking it upon ourselves to learn about what causes our blood sugars to rise suddenly or gently, we can manage our diet and other lifestyle factors accordingly.

    And yes, it’s not just about diet, Dr. Means tells us. While added sugar and refined carbohydrates or indeed the main drivers of glycemic variability, our sleep, movement, stress management, and even toxin exposure play important parts too.

    One way to do this, that Dr. Means recommends, is with a continuous glucose monitor:

    Track Your Blood Sugars For Better Personalized Health

    Another way is to just apply principles that work for almost everyone:

    10 Ways To Balance Blood Sugars

    Want to know more from Dr. Means?

    You might like her book:

    Good Energy – by Dr. Casey Means

    …which goes into this in far more detail than we have room to today.

    Enjoy!

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  • Singledom & Healthy Longevity

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    Statistically, those who live longest, do so in happy, fulfilling, committed relationships.

    Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.

    We wrote about this here:

    Only One Kind Of Relationship Promotes Longevity This Much!

    But that’s not the full story

    For a start, while being in a happy fulfilling committed relationship statistically adds healthy life years, being in a relationship that falls short of those adjectives certainly does not. See also:

    Relationships: When To Stick It Out & When To Call It Quits

    But also, life satisfaction steadily improves with age, for single people (the results are more complicated for partnered people—probably because of the range of difference in quality of relationships). At least, this held true in this large (n=6,188) study of people aged 40–85 years:

    ❝With advancing age, partnership status became less predictive of loneliness and the satisfaction with being single increased. Among later-born cohorts, the association between partnership status and loneliness was less strong than among earlier-born cohorts. Later-born single people were more satisfied with being single than their earlier-born counterparts.❞

    Source: The Changing Relationship Between Partnership Status and Loneliness: Effects Related to Aging and Historical Time

    Note that this does mean that while life satisfaction indeed improves with age for single people, that’s a generalized trend, and the greatest life satisfaction within this set of singles comes hand-in-hand with being single by choice rather than by perceived obligation, i.e., those who are “single and not looking” will generally be the most content, and this contentedness will improve with age, but for those who are “single and looking”, in that case it’s the younger people who have it better, likely due to a greater sense of having plenty of time.

    For that matter, gender plays a role; this large survey of singles found that (despite the popular old pop-up ads advising that “older women in your area are looking to date”), in reality older single women were the least likely to actively look for a partner:

    See: A Profile Of Single Americans

    …which also shows that about half of single Americans are “not looking”, and of those who are, about half are open to a serious relationship, though this is more common under the age of 40, while being over the age of 40 sees more people looking only for something casual.

    Take-away from this section: being single only decreases life satisfaction if one doesn’t enjoy being single, and even then, and increases it if one does enjoy being single.

    But that’s about life satisfaction, not longevity

    We found no studies specifically into longevity of singledom, only the implications that may be drawn from the longevity of partnered people.

    However, there is a lot of research that shows it’s not being single that kills, it’s being socially isolated. It’s a function of neurodegeneration from a lack of conversation, and it’s a function of what happens when someone slips in the shower and is found a week later. Things like that.

    For example: Is Living Alone “Aging Alone”? Solitary Living, Network Types, and Well-Being

    What if you are alone and don’t want to be?

    We’ve not, at time of writing, written dating advice in our Psychology Sunday section, but this writer’s advice is:don’t even try.

    That’s not nihilism or even cynicism, by the way; it’s actually a kind of optimism. The trick is just to let them come to you.

    (sample size of one here, but this writer has never looked for a relationship in her life, they’ve always just found me, and now that I’m widowed and intend to remain single, I still get offers—and no, I’m not a supermodel, nor rich, nor anything like that)

    Simply: instead of trying to find a partner, just work on expanding your social relationships in general (which is much easier, because the process is something you can control, whereas the outcome of trying to find a suitable partner is not), and if someone who’s right for you comes along, great! If not, then well, at least you have a flock of friends now, and who knows what new unexpected romance may lie around the corner.

    As for how to do that,

    How To Beat Loneliness & Isolation

    Take care!

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  • The Art and Science of Connection – by Kasley Killam, MPH

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    We can eat well, exercise well, and even sleep well, and we’ll still have a +53% increased all-cause mortality if we lack social connection—even if we technically have support and access to social resources, just not the real human connection itself. And as we get older, it gets increasingly easy to find ourselves isolated.

    The author is a social scientist by profession, and it shows. None of what she shares in the book is wishy-washy; it has abundant scientific references coming thick and fast, and a great deal of clarity with regard to terms, something often not found in books of this genre that lean more towards the art than the science.

    On which note, for the reader who may be thinking “I am indeed quite alone”, she also offers proven techniques for remedying that; not in the way that many books use the word “proven” to mean “we got some testimonials”, but rather, proven in the sense of “we did science to it and based on these 17 large population-based retrospective cohort studies, we can say with 99% confidence that this is an effective tool to mediate improved social bonds and social health outcomes”.

    To this end, it’s a very practical book also, and should bestow upon any isolated reader a sense of confidence that in fact, things can be better. A particular strength is that it also looks at many different scenarios, so for the “what if I…” people with clear reasons why social connection is not abundantly available, yes, she has such cases covered too.

    Bottom line: if you’d like to live more healthily for longer, social health is an underrated and oft-forgotten way of greatly increasing those things, by science.

    Click here to check out The Art And Science Of Social Connection, and get connected!

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  • No, sugar doesn’t make your kids hyperactive

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    It’s a Saturday afternoon at a kids’ birthday party. Hordes of children are swarming between the spread of birthday treats and party games. Half-eaten cupcakes, biscuits and lollies litter the floor, and the kids seem to have gained superhuman speed and bounce-off-the-wall energy. But is sugar to blame?

    The belief that eating sugary foods and drinks leads to hyperactivity has steadfastly persisted for decades. And parents have curtailed their children’s intake accordingly.

    Balanced nutrition is critical during childhood. As a neuroscientist who has studied the negative effects of high sugar “junk food” diets on brain function, I can confidently say excessive sugar consumption does not have benefits to the young mind. In fact, neuroimaging studies show the brains of children who eat more processed snack foods are smaller in volume, particularly in the frontal cortices, than those of children who eat a more healthful diet.

    But today’s scientific evidence does not support the claim sugar makes kids hyperactive.

    Sharomka/Shutterstock

    The hyperactivity myth

    Sugar is a rapid source of fuel for the body. The myth of sugar-induced hyperactivity can be traced to a handful of studies conducted in the 1970s and early 1980s. These were focused on the Feingold Diet as a treatment for what we now call Attention Deficit Hyperactivity Disorder (ADHD), a neurodivergent profile where problems with inattention and/or hyperactivity and impulsivity can negatively affect school, work or relationships.

    Devised by American paediatric allergist Benjamin Feingold, the diet is extremely restrictive. Artificial colours, sweeteners (including sugar) and flavourings, salicylates including aspirin, and three preservatives (butylated hydroxyanisole, butylated hydroxytoluene, and tert-Butrylhdryquinone) are eliminated.

    Salicylates occur naturally in many healthy foods, including apples, berries, tomatoes, broccoli, cucumbers, capsicums, nuts, seeds, spices and some grains. So, as well as eliminating processed foods containing artificial colours, flavours, preservatives and sweeteners, the Feingold diet eliminates many nutritious foods helpful for healthy development.

    However, Feingold believed avoiding these ingredients improved focus and behaviour. He conducted some small studies, which he claimed showed a large proportion of hyperactive children responded favourably to his diet.

    bowls of lollies on table
    Even it doesn’t make kids hyperactive, they shouldn’t have too much sugar. DenisMArt/Shutterstock

    Flawed by design

    The methods used in the studies were flawed, particularly with respect to adequate control groups (who did not restrict foods) and failed to establish a causal link between sugar consumption and hyperactive behaviour.

    Subsequent studies suggested less than 2% responded to restrictions rather than Feingold’s claimed 75%. But the idea still took hold in the public consciousness and was perpetuated by anecdotal experiences.

    Fast forward to the present day. The scientific landscape looks vastly different. Rigorous research conducted by experts has consistently failed to find a connection between sugar and hyperactivity. Numerous placebo-controlled studies have demonstrated sugar does not significantly impact children’s behaviour or attention span.

    One landmark meta-analysis study, published almost 20 years ago, compared the effects of sugar versus a placebo on children’s behaviour across multiple studies. The results were clear: in the vast majority of studies, sugar consumption did not lead to increased hyperactivity or disruptive behaviour.

    Subsequent research has reinforced these findings, providing further evidence sugar does not cause hyperactivity in children, even in those diagnosed with ADHD.

    While Feingold’s original claims were overstated, a small proportion of children do experience allergies to artificial food flavourings and dyes.

    Pre-school aged children may be more sensitive to food additives than older children. This is potentially due to their smaller body size, or their still-developing brain and body.

    Hooked on dopamine?

    Although the link between sugar and hyperactivity is murky at best, there is a proven link between the neurotransmitter dopamine and increased activity.

    The brain releases dopamine when a reward is encountered – such as an unexpected sweet treat. A surge of dopamine also invigorates movement – we see this increased activity after taking psychostimulant drugs like amphetamine. The excited behaviour of children towards sugary foods may be attributed to a burst of dopamine released in expectation of a reward, although the level of dopamine release is much less than that of a psychostimulant drug.

    Dopamine function is also critically linked to ADHD, which is thought to be due to diminished dopamine receptor function in the brain. Some ADHD treatments such as methylphenidate (labelled Ritalin or Concerta) and lisdexamfetamine (sold as Vyvanse) are also psychostimulants. But in the ADHD brain the increased dopamine from these drugs recalibrates brain function to aid focus and behavioural control.

    girl in yellow top licks large lollipop while holding a pink icecream
    Maybe it’s less of a sugar rush and more of a dopamine rush? Anastasiya Tsiasemnikava/Shutterstock

    Why does the myth persist?

    The complex interplay between diet, behaviour and societal beliefs endures. Expecting sugar to change your child’s behaviour can influence how you interpret what you see. In a study where parents were told their child had either received a sugary drink, or a placebo drink (with a non-sugar sweetener), those parents who expected their child to be hyperactive after having sugar perceived this effect, even when they’d only had the sugar-free placebo.

    The allure of a simple explanation – blaming sugar for hyperactivity – can also be appealing in a world filled with many choices and conflicting voices.

    Healthy foods, healthy brains

    Sugar itself may not make your child hyperactive, but it can affect your child’s mental and physical health. Rather than demonising sugar, we should encourage moderation and balanced nutrition, teaching children healthy eating habits and fostering a positive relationship with food.

    In both children and adults, the World Health Organization (WHO) recommends limiting free sugar consumption to less than 10% of energy intake, and a reduction to 5% for further health benefits. Free sugars include sugars added to foods during manufacturing, and naturally present sugars in honey, syrups, fruit juices and fruit juice concentrates.

    Treating sugary foods as rewards can result in them becoming highly valued by children. Non-sugar rewards also have this effect, so it’s a good idea to use stickers, toys or a fun activity as incentives for positive behaviour instead.

    While sugar may provide a temporary energy boost, it does not turn children into hyperactive whirlwinds.

    Amy Reichelt, Senior Lecturer (Adjunct), Nutritional neuroscientist, University of Adelaide

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Rehab Science – by Dr. Tom Walters 

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    Many books of this kind deal with the injury but not the pain; some source talk about pain but not the injury; this one does both, and more.

    Dr. Walters discusses in detail the nature of pain, various different kinds of pain, the factors that influence pain, and, of course, how to overcome pain.

    He also takes us on a tour of various different categories of injury, because some require very different treatment than others, and while there are some catch-all “this is good/bad for healing” advices, sometimes what will help with one injury with hinder healing another. So, this information alone would make the book a worthwhile read already.

    After this two-part theory-heavy introduction, the largest part of the book is given over to rehab itself, in a practical fashion.

    We learn about how to make an appropriate rehab plan, get the material things we need for it (if indeed we need material things), and specific protocols to follow for various different body parts and injuries.

    The style is very much that of a textbook, well-formatted and with plenty of illustrations throughout (color is sometimes relevant, so we recommend a print edition over Kindle for this one).

    Bottom line: if you have an injury to heal, or even just believe in being prepared, this book is an excellent guide.

    Click here to check out Rehab Science, to overcome pain and heal from injury!

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  • Swordfish vs Tuna – Which is Healthier?

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    Our Verdict

    When comparing swordfish to tuna, we picked the tuna.

    Why?

    Today in “that which is more expensive is not necessarily the healthier”…

    Considering the macros first, swordfish has more than 8x more total fat, about 9x more saturated fat, and yes, more cholesterol. On the other hand, tuna has more protein. An easy win for tuna.

    In terms of vitamins, swordfish has more of vitamins A, B5, D, and E, while tuna has more of vitamins B1, B2, B3, B6, and B12. A marginal win for tuna, unless you want to weight the other vitamins more heavily, in which case, more likely a tie, or maybe even an argument for swordfish if you have a particular vitamin deficiency on that side.

    When it comes to minerals, swordfish has more calcium and zinc, while tuna has more iron, magnesium, manganese, phosphorus, potassium, and selenium. A clear win for tuna.

    One other thing: they’re both very rich in mercury, and while tuna is bad for that, swordfish has nearly 3x as much.

    In short, both have a good spread of vitamins and minerals, and both are quite tainted with mercury, but in relative terms, there’s a clear winner even before considering the very different macros, and the winner is tuna.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: Important Differences

    Take care!

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