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:
- Endometriosis Coalition Patient Support Group (virtual)
- MyEndometriosisTeam (virtual)
- Endo Black, Inc. (Washington, D.C.)
- endoQueer (virtual)
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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Here’s To Getting Assuredly Good Health
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An unusual amount of excitement in the health news world this week, with health insurance in the spotlight:
Deny, Delay, Depose?
Insurance company UnitedHealthcare, which used AI with a 90% error rate to deny insurance claims (of which, disproportionately denying insurance claims of the elderly), has come under extra public scrutiny this week for its recent-years business practices:
❝Nearly 1 in 5 insured adults experienced claim denials during a 12-month period.
Those with job-based insurance or Affordable Care Act policies ran into this problem about twice as often as those covered by Medicare or Medicaid❞
…although, the company has dramatically increased its care denials for Medicare Advantage enrollees, doubling the rate of denials as it implemented its new, automated denials process.
Anesthesiologist Dr. Brain Schmutzler noted:
❝We have a bigger issue with the insurance companies in general, who, essentially, it’s their job to make money, not to actually pay for health care❞
And in those cases where healthcare is not denied, it is often dangerously delayed, as insurance companies can stall for time to decide whether they’re going to pay or not.
One useful take-away from all of this is that if your insurance claim is denied, consider fighting it, as often they can be overturned.
Specifically, it can be good to insist on knowing who (named persons) was involved in the denial process, and their qualifications. Once upon a time, this was mostly unqualified interns, which prompted insurance companies to reverse the denial rather than admit that; nowadays it’s mostly AI, which many companies can hope will shield them from culpability—either way, fighting for one’s rights can often be successful.
Read in full: Killing of UnitedHealthcare CEO prompts flurry of stories on social media over denied insurance claims
Related: With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help
Rest Easy
Health insurer Elevance Health (formerly Anthem Blue Cross Blue Shield), had last month announced plans to limit its coverage for anesthesia used in operations, whereby they would pay for only a certain amount of anesthetic, and if the procedure was still ongoing when that amount had been used, then well, you were on your own.
However, on Thursday afternoon and allegedly completely coincidentally in the wake of the Wednesday assassination of the CEO who oversaw the denial of so many health insurance claims, this decision to limit paying for anesthesia was reversed, retracted, and they are now doing their best to downplay what the proposal would have meant for anesthesiologists and patients:
Read in full: Insurance company halts plan to put time limits on coverage for anesthesia during surgery
Related: The Insider’s Guide To Making Hospital As Comfortable As Possible ← an anesthesiologist’s tips
Getting a good grip of your health
What’s the best indicator of good health when it comes to age-related health issues? It’s not BMI! Could it be blood pressure? It could, but the news presently is about grip strength.
While training to have an amazing grip (and neglecting all else) will not necessarily increase your general healthspan, having a weak or strong grip is strongly associated with, respectively, having weak or strong general health in later years.
This is because unless someone has been training very unnaturally, grip strength is a good general measure of overall muscle strength, which in turn is a good indicator of metabolic health, as well as bodily robustness.
Read in full: Handgrip strength is a reliable predictor for age-related disease and disability, finds study
Related: Resistance Is Useful! (Especially As We Get Older)
Take care!
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I’ve recovered from a cold but I still have a hoarse voice. What should I do?
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Cold, flu, COVID and RSV have been circulating across Australia this winter. Many of us have caught and recovered from one of these common upper respiratory tract infections.
But for some people their impact is ongoing. Even if your throat isn’t sore anymore, your voice may still be hoarse or croaky.
So what happens to the voice when we get a virus? And what happens after?
Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.
Why does my voice get croaky during a cold?
A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.
The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.
When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.
Viruses such as the common cold can inflame the vocal cords. Pepermpron/Shutterstock Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.
In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.
Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip). But coughing slams the vocal cords together with force.
Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.
Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.
Coughing and exertion can cause inflamed vocal cords to thicken and develop nodules. Pepermpron/Shutterstock How can you care for your voice during infection?
People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk of forcing their voice before it’s ready.
The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.
Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.
Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.
Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles.
Instead, consider using “confidential voice”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.
During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.
What should you do if your voice is still hoarse after recovery?
If your voice hasn’t returned to normal after two to three weeks, you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.
If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated with voice therapy and don’t require surgery.
You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.
In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.
Yeptain Leung, Postdoctoral Research and Lecturer of Speech Pathology, School of Health Sciences, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Be Your Future Self Now – by Dr. Benjamin Hardy
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Affirmations in the mirror are great and all, but they can only get you so far! And if you’re a regular reader of our newsletter, you probably know about the power of small daily habits adding up and compounding over time. So what does this book offer, that’s different?
“Be Your Future Self Now” beelines the route “from here to there”, with a sound psychological approach. On which note…
The book’s subtitle mentions “the science of intentional transformation”, and while Dr. Hardy is a psychologist, he’s an organizational psychologist (which doesn’t really pertain to this topic). It’s not a science-heavy book, but it is heavy on psychological rationality.
Where Dr. Hardy does bring psychology to bear, it’s in large part that! He teaches us how to overcome our biases that cause us to stumble blindly into the future… rather than intentfully creating our own future to step into. For example:
Most people (regardless of age!) acknowledge what a different person they were 10 years ago… but assume they’ll be basically the same person 10 years from now as they are today, just with changed circumstances.
Radical acceptance of the inevitability of change is the first step to taking control of that change.
That’s just one example, but there are many, and this is a book review not a book summary!
In short: if you’d like to take much more conscious control of the direction your life will take, this is a book for you.
Click here to get your copy of “Be Your Future Self Now” from Amazon!
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Natural Alternatives for Depression Treatment
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Natural alternatives to medication for depression?
Great question! We did a mean feature a while back, but we definitely have much more to say! We’ll do another main feature soon, but in the meantime, here’s what we previously wrote:
See: The Mental Health First-Aid That You’ll Hopefully Never Need
^This covers not just the obvious, but also why the most common advice is not helpful, and practical tips to actually make manageable steps back to wellness, on days when “literally just survive the day” is one’s default goal.
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Clean – by Dr. James Hamblin
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Our skin is our largest organ, and it’s easy to forget that, and how much it does for us. All things considered, it’s good to take good care of it! But what if we sometimes take too much “care” of it?
Dr. James Hamblin, a medical doctor-turned-writer, has explored this a lot both personally and in research. Through such, he has come to the conclusion there’s definitely a “sweet spot” of personal hygiene:
- Too little, and the Bubonic plague sweeps through Europe, or other plagues sweep through other places when European invaders came.
- Too much, and we strip our skin of one of its greatest qualities: the ability to protect us.
Dr. Hamblin asks (and answers) such questions as:
- What is good hygiene, and what is neurotically doing ourselves multiple levels of harm because advertising companies shamed us into doing so?
- Is it good or bad to use a series of products, each to undo the problem caused by the previous?
- What the difference between a 5-step skincare routine, and a series of gratuitous iatrogenic damage?
- Which products clean us most helpfully, and which clean us most harmfully?
- How often should we bathe/shower, really?
If the book has a weak point, it’s that it’s written mostly with his body in mind. That makes a difference when it comes to hairwashing, for example. He’s a white guy with short hair. If you’re black and/or have long hair, for example, your haircare needs will be quite different. Similarly, many women engage in shaving/depilation in places that most men don’t, and the consequences of that choice (and implications for any extra washing needs/harms) aren’t covered.
Bottom line: notwithstanding the aforementioned blind-spots, this book will help readers reduce the amount of harm we are doing to our bodies with our washing routines, without sacrificing actual hygiene.
Click here to check out Clean and help your skin to help you!
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The Princess of Wales wants to stay cancer-free. What does this mean?
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Catherine, Princess of Wales, has announced she has now completed a course of preventive chemotherapy.
The news comes nine months after the princess first revealed she was being treated for an unspecified form of cancer.
In the new video message released by Kensington Palace, Princess Catherine says she’s focused on doing what she can to stay “cancer-free”. She acknowledges her cancer journey is not over and the “path to recovery and healing is long”.
While we don’t know the details of the princess’s cancer or treatment, it raises some questions about how we declare someone fully clear of the disease. So what does being – and staying – “cancer-free” mean?
Pete Hancock/Shutterstock What’s the difference between being cancer-free and in remission?
Medically, “cancer-free” means two things. First, it means no cancer cells are able to be detected in a patient’s body using the available testing methods. Second, there is no cancer left in the patient.
These might sound basically the same. But this second aspect of “cancer-free” can be complicated, as it’s essentially impossible to be sure no cancer cells have survived a treatment.
Testing can’t completely rule out the chance some cancer cells have survived treatment. Andrewshots/Shutterstock It only takes a few surviving cells for the cancer to grow back. But these cells may not be detectable via testing, and can lie dormant for some time. The possibility of some cells still surviving means it is more accurate to say a patient is “in remission”, rather than “cancer-free”.
Remission means there is no detectable cancer left. Once a patient has been in remission for a certain period of time, they are often considered to be fully “cancer-free”.
Princess Catherine was not necessarily speaking in the strict medical sense. Nonetheless, she is clearly signalling a promising step in her recovery.
What happens during remission?
During remission, patients will usually undergo surveillance testing to make sure their cancer hasn’t returned. Detection tests can vary greatly depending on both the patient and their cancer type.
Many tests involve simply looking at different organs to see if there are cancer cells present, but at varying levels of complexity.
Some cancers can be detected with the naked eye, such as skin cancers. In other cases, technology is needed: colonoscopies for colorectal cancers, X-ray mammograms for breast cancers, or CT scans for lung cancers. There are also molecular tests, which test for the presence of cancer cells using protein or DNA from blood or tissue samples.
For most patients, testing will continue for years at regular intervals. Surveillance testing ensures any returning cancer is caught early, giving patients the best chance of successful treatment.
Remaining in remission for five years can be a huge milestone in a patient’s cancer journey. For most types of cancer, the chances of cancer returning drop significantly after five years of remission. After this point, surveillance testing may be performed less frequently, as the patients might be deemed to be at a lower risk of their cancer returning.
Skin cancer may be detected by the naked eye, but many other cancers require technology for detection and monitoring. wavebreakmedia/Shutterstock Measuring survival rates
Because it is very difficult to tell when a cancer is “cured”, clinicians may instead refer to a “five-year survival rate”. This measures how likely a cancer patient is to be alive five years after their diagnosis.
For example, data shows the five-year survival rate for bowel cancer among Australian women (of all ages) is around 70%. That means if you had 100 patients with bowel cancer, after five years you would expect 70 to still be alive and 30 to have succumbed to the disease.
These statistics can’t tell us much about individual cases. But comparing five-year survival rates between large groups of patients after different cancer treatments can help clinicians make the often complex decisions about how best to treat their patients.
The likelihood of cancer coming back, or recurring, is influenced by many factors which can vary over time. For instance, approximately 30% of people with lung cancer develop a recurrent disease, even after treatment. On the other hand, breast cancer recurrence within two years of the initial diagnosis is approximately 15%. Within five years it drops to 10%. After ten, it falls below 2%.
These are generalisations though – recurrence rates can vary greatly depending on things such as what kind of cancer the patient has, how advanced it is, and whether it has spread.
Staying cancer-free
Princess Catherine says her focus now is to “stay cancer-free”. What might this involve?
How a cancer develops and whether it recurs can be influenced by things we can’t control, such as age, ethnicity, gender, genetics and hormones.
However, there are sometimes environmental factors we can control. That includes things like exposure to UV radiation from the sun, or inhaling carcinogens like tobacco.
Lifestyle factors also play a role. Poor diet and nutrition, a lack of exercise and excessive alcohol consumption can all contribute to cancer development.
Research estimates more than half of all cancers could potentially be prevented through regular screening and maintaining a healthy lifestyle (not to mention preventing other chronic conditions such as heart disease and diabetes).
Recommendations to reduce cancer risk are the same for everyone, not just those who’ve had treatment like Princess Catherine. They include not smoking, eating a nutritious and balanced diet, exercising regularly, cutting down on alcohol and staying sun smart.
Amali Cooray, PhD Candidate in Genetic Engineering and Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) ; John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) , and Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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