Menstruation, or a period, is the bleeding that occurs about monthly in healthy people born with a uterus, from puberty to menopause. This happens when the endometrium, the tissue that lines the inside of the uterus, is shed.

Endometriosis is a condition that occurs when endometrium-like tissue is found outside the uterus, usually within the pelvic cavity. It is often considered a major cause of pelvic pain.

Pelvic pain significantly impacts quality of life. But how can you tell the difference between period pain and endometriosis?

Periods and period pain

Periods involve shedding the 4-6 millimetre-thick endometrial lining from the inside of the uterus.

As the lining detaches from the wall of the uterus, the blood vessels which previously supplied the lining bleed. The uterine muscles contract, expelling the blood and crumbled endometrium.

The crumbled endometrium and blood mostly pass through the cervix and vagina. But almost everyone back-bleeds via their fallopian tubes into their pelvic cavity. This is known as “retrograde menstruation”.

The process of menstrual shedding is caused by inflammatory substances, which also cause nausea, vomiting, diarrhoea, headaches, aches, pains, dizziness, feeling faint, as well as stimulating pain receptors.

These inflammatory substances are responsible for the pain and symptoms in the week before a period and the first few days.

For women with heavy periods, their worst days of pain are usually the heaviest days of their period, coinciding with more cramps to expel clots and more retrograde bleeding.

Many women also have pain when they are releasing an egg from their ovary at the time of ovulation. Ovulation or mid-cycle pain can be worse in those who bleed more, as those women are more likely to bleed into the ovulation follicle.

Around 90% of adolescents experience period pain. Among these adolescents, 20% will experience such severe period pain they need time off from school and miss activities. These symptoms are too often normalised, without validation or acknowledgement.

What about endometriosis?

Many symptoms have been attributed to endometriosis, including painful periods, pain with sex, bladder and bowel-related pain, low back pain and thigh pain.

Other pain-related conditions such migraines and chronic fatigue have also been linked to endometriosis. But these other pain-related symptoms occur equally often in people with pelvic pain who don’t have endometriosis.

Repeated, significant period and ovulation pain can eventually lead some people to develop persistent or chronic pelvic pain, which lasts longer than six months. This appears to occur through a process known as central sensitisation, where the brain becomes more sensitive to pain and other sensory stimuli.

Central sensitisation can occur in people with persistent pain, independent of the presence or absence of endometriosis.

Eventually, many people with period and/or persistent pelvic pain will have an operation called a laparoscopy, which allows surgeons to examine organs in the pelvis and abdomen, and diagnose and treat endometriosis.

Yet only 50% of those with identical pain symptoms who undergo a laparoscopy will end up having endometriosis.

Endometriosis is also found in pain-free women. So we cannot predict who does and doesn’t have endometriosis from symptoms alone.

How is this pain managed?

Endometriosis surgery usually involves removing lesions and adhesions. But at least 30% of people return to pre-surgery pain levels within six months or have more pain than before.

After surgery, emergency department presentations for pain are unchanged and 50% have repeat surgery within a few years.

Suppressing periods using hormonal therapies (such as continuous oral contraceptive pills or progesterone-only approaches) can suppress endometriosis and reduce or eliminate pain, independent of the presence or absence of endometriosis.

Not every type or dose of hormonal medications suits everyone, so medications need to be individualised.

The current gold-standard approach to manage persistent pelvic pain involves a multidisciplinary team approach, with the aim of achieving sustained remission and improving quality of life. This may include:

• physiotherapy for pelvic floor and other musculoskeletal problems
• management of bladder and bowel symptoms
• support for self-managing pain
• lifestyle changes including diet and exercise
• psychological or group therapy, as our moods, stress levels and childhood events can affect how we feel and experience pain.

Whether you have period pain, chronic pelvic pain or pain you think is associated with endometriosis, if you feel pain, it’s real. If it’s disrupting your life, you deserve to be taken seriously and treated as the whole person you are.

Sonia R. Grover, Senior Research Fellow, Murdoch Children’s Research Institute; Clinical Professor of Gynaecology, The University of Melbourne

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

The human brain is remarkably complex, with trillions of connections that control how you move, think and feel.

Yet it’s still vulnerable to debilitating conditions such as paralysis, stroke, epilepsy and various neurodegenerative diseases.

Scientists are investigating if a kind of technology, known as the brain-computer interface, could help patients move and communicate better.

So how does it work? And what are the potential risks?

What is a brain-computer interface?

A brain-computer interface works by reading electrical signals produced by the brain, which it translates into digital signals that an external computer can understand. The computer then sends instructions – such as the command to move a cursor, steer a wheelchair or read a sentence aloud – back to the brain. This whole process happens in real time, allowing patients to do tasks more independently.

There are two types of brain-computer interfaces:

Non-invasive

Non-invasive brain-computer interfaces are worn externally, usually in the form of electroencephalogram headsets. An electroencephalogram, or an EEG, is a type of test that measures activity in the brain. This technology is already available on the consumer market, found in everything from meditation apps to video games.

Invasive

Invasive brain-computer interfaces are surgically implanted. This involves placing electrodes – devices that carry electrical signals from the body to medical instruments – directly onto the exposed surface of the brain. These interfaces aim to help restore key functions such as speech and mobility in people with a disability, caused by conditions such as stroke or spinal cord injury.

It is this second category that’s attracting attention from investors and scientists. Several companies – including early developer Blackrock Neurotech, Australian-owned Synchron, and Elon Musk’s Neuralink – are racing to get implantable brain-computer interfaces to patients.

Under current regulations, only a handful of clinical trial participants globally can access this technology. But this may change as interest grows. The international brain-computer interface market is expected to be worth roughly A$14 billion by 2033, up from its current value of just under $3 billion.

Their role in health care

Brain implants may sound dystopian, but they are a promising part of neuroscience research.

More than three billion people worldwide live with a neurological condition that affects their motor, communication or sensory functions. Examples include stroke, epilepsy, Parkinson’s disease, cerebral palsy and traumatic brain injury.

Brain-computer interfaces are particularly helpful for communication. In one 2023 study, paralysed patients that used a brain-computer interface were able to communicate up to 78 words per minute. That’s a five-fold improvement from the 15 words per minute achieved by patients in 2021. And recent research shows this technology is still rapidly improving.

Beyond communication, surgeons are using brain-computer interfaces to map brain activity in real time. This is particularly useful during complex or high-risk procedures, where surgeons must protect key brain regions.

Sleep researchers are also using this technology to analyse brain signals in people who may have a sleep disorder, such as insomnia or sleep apnoea. Brain-computer interfaces may be a more accurate way to diagnose and treat such disorders, compared to other methods such as sleep diaries that rely on participant reports.

Scientists are also investigating how these interfaces could be used in rehabilitation, particularly for people with conditions such as depression, epilepsy, stroke and Parkinson’s disease.

What are the risks?

Here are three worth noting.

Physical harm

Any kind of brain implant can cause physical damage that may affect how neighbouring brain regions work.

For example, if there’s bleeding in a part of the brain that controls speech or movement, even a small blot clot could impair those functions. And while infections in the brain are rare, they can cause swelling and further complications if not immediately treated.

Research suggests there are long-term effects of having foreign material inside the skull. Over time, the brain treats the implant as an intruder, forming scar tissue around it in a bid to destroy nearby brain cells and stop the implant from working. Regular movements such as breathing may also create friction between the hard implant and soft brain tissue, causing some brain regions to become inflamed.

Cybersecurity threats

One recent study found a large-scale breach of brain-computer interface systems could theoretically allow hackers to access sensitive neural data, such as patients’ thoughts and memories. Hacking may also enable them to impair a patient’s cognitive functions such as the ability to concentrate, or even manipulate motor signals to affect how well they move. That’s a scary prospect, especially if these devices become more common in health care and other sectors. In the United States, some jurisdictions are already working to protect neural data rights in law, but there are still major regulatory gaps.

Unequal access

Currently, getting a brain implant will set you back between $50,000 to $140,000. That doesn’t include the cost of ongoing maintenance and follow-up care. So ordinary patients are unlikely to access this technology anytime soon, widening the gap between who can and can’t afford to improve their health.

Where to next

Brain-computer interfaces are a promising new technology, but they come with risks.

We urgently need more high-quality research into the long-term effects – both physical and psychological – of permanent brain implants. Importantly, this research should be funded publicly and not just by a handful of large, profit-driven companies.

David Tuffley, Adjunct Senior Lecturer, Applied Ethics and CyberSecurity, Griffith University

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

An estimated one in five women and one in 16 men in Australia have experienced sexual violence.

After such a traumatic experience, it’s understandable many are unsure if they want to report it to the police. In fact, less than 10% of Australian women who experience sexual assault ever make a police report.

In Australia there is no time limit on reporting sexual assault to police. However, there are tight time frames for collecting forensic evidence, which can sometimes be an important part of the police investigation, whether it’s commenced at the time or later.

This means the decision of whether or not to undergo a medical forensic examination needs to be made quite quickly after an assault.

I work as a medical forensic examiner. Here’s what you can expect if you present for a medical forensic examination after a sexual assault.

A team of specialists

There are about 100 sexual assault services throughout Australia providing 24-hour care. As with other areas of health care, there are extra challenges in regional and rural areas, where there are often further distances to travel and staff shortages.

Sexual assault services in Australia are free regardless of Medicare status. To find your nearest service you can call 1800 RESPECT (1800 737 732) or Full Stop Australia (1800 385 578) who can also provide immediate telephone counselling support.

It’s important to call the local sexual assault service before turning up. They can provide the victim-survivor with information and advice to prevent delays and make the process as helpful as possible.

The consultation usually occurs in a hospital emergency department which has a designated forensic suite, or in a specialised forensic service.

The victim-survivor is seen by a doctor or nurse trained in medical and forensic care. There’s a sexual assault counsellor, crisis worker or social worker present to support the patient and offer counselling advice. This is called an “integrated response” with medical and psychosocial staff working together.

In most cases the victim-survivor can have their own support person present too.

Depending on what the victim-survivor wants, the doctor or nurse will take a history of the assault to guide any medical care which may be needed (such as emergency contraception) and to guide the examination.

Sexual assault services are always very aware of giving victim-survivors a choice about having a medical forensic examination. If a person presents to a sexual assault service, they can receive counselling and medical care without undergoing a forensic examination if they do not wish to. https://www.youtube.com/embed/CGlbTgia0Ek?wmode=transparent&start=0 Sexual assault services are inclusive of all genders.

Collecting forensic samples

Samples collected during a medical forensic examination can sometimes identify the perpetrator’s DNA or intoxicating substances (alcohol or drugs that might be relevant to the investigation). The window of opportunity to collect these samples can be as short as 12 hours, or up to 5–7 days, depending on the nature of the sexual assault.

In most of Australia, an adult who has experienced a recent sexual assault can be offered a medical forensic examination without making a report to police.

Depending on the state or territory, the forensic samples can usually be stored for 3 to 12 months (up to 100 years in Tasmania). This allows the victim-survivor time to decide if they want to release them to police for processing.

The doctor or nurse will collect the samples using a sexual assault investigation kit, or a “rape kit”.

Collecting these samples might involve taking swabs to try to detect DNA from external and internal genital areas and anywhere there may have been DNA transfer. This can be from skin cells, where the perpetrator touched the victim-survivor, or from bodily fluids including semen or saliva.

The doctor or nurse carrying out the examination do their best to minimise re-traumatisation, by providing the victim-survivor information, choices and control at every step of the process.

How about STIs and pregnancy?

During the consultation, the doctor or nurse will address any concerns about sexually transmitted infections (STIs) and pregnancy, if applicable.

In most cases the risk of STIs is small. But follow-up testing at 1–2 weeks for infections such as chlamydia and gonorrhoea, and at 6–12 weeks for infections such as syphilis and HIV, is usually recommended.

Emergency contraception (sometimes called the “morning after pill”) can be provided to prevent pregnancy. It can be taken up to five days after sexual assault (but the sooner the better) with follow-up pregnancy testing recommended at 2–3 weeks.

Things have improved over time

When I was a junior doctor in the late 90s, taking forensic swabs was usually the responsibility of the busy obstetrics and gynaecology trainee in the emergency department, who was often managing multiple patients and had little training in forensics. There was also usually no supportive counsellor.

Anecdotally, both the doctor and the patient were traumatised by this experience. Research shows that when specialised, integrated services are not provided, victim-survivors’ feelings of powerlessness are magnified.

But the way we carry out medical forensic examinations after sexual assault in Australia has improved over the years.

With patient-centred practices, and designated forensic and counselling staff, the experience for the patient is thought to be empowering rather than re-traumatising.

Our research

In new research published in the Australian Journal of General Practice, my colleagues and I explored the experience of the medical forensic examination from the victim-survivor’s perspective.

We surveyed 291 patients presenting to a sexual assault service in New South Wales (where I work) over four years.

Some 75% of patients reported the examination was reassuring and another 20% reported it was OK. Only 2% reported that it was traumatising. The majority (98%) said they would recommend a friend present to a sexual assault service if they were in a similar situation.

While patients spoke positively about the care they received, many commented that the sexual assault service was not visible enough. They didn’t know how to find it or even that it existed.

We know many victim-survivors don’t present to a sexual assault service or undergo a medical forensic examination after a sexual assault. So we need to do more to increase the visibility of these services.

The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.

Mary Louise Stewart, Senior Career Medical Officer, Northern Sydney Local Health District; PhD Candidate, University of Sydney

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