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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Artichoke vs Brussels Sprouts – Which is Healthier?
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Our Verdict
When comparing artichoke to Brussels sprouts, we picked the sprouts.
Why?
Finally, a vegetable that beats artichoke—after it previously beat heart-of-palm, asparagus, and even cabbage! It was still close though, which is impressive for artichoke, considering what a nutritional powerhouse Brussels sprouts are:
In terms of macros, the only meaningful difference is that artichoke has slightly more carbs and fiber, so artichoke gets the most marginal of nominal wins in this category.
In the category of vitamins, however, artichoke has more of vitamins B3, B9, and choline, while Brussels sprouts have more of vitamins A, B1, B2, B6, C, E, and K, giving sprouts the clear victory here, especially with much higher margins of difference (e.g. 58x more vitamin A, as well as 7x more vitamin C, and 10x more vitamin K).
When it comes to minerals, artichoke has more copper, magnesium, phosphorus, and zinc, while Brussels sprouts have more iron, manganese, potassium, and selenium, resulting in a 4:4 tie, and the small margins of difference are mostly comparable, with the exception that sprouts have 8x more selenium. So, Brussels sprouts win this category very marginally on that tie-breaker.
Adding up the sections we see that macros and minerals gave a small win each to artichoke and sprouts respectively, while the vitamins category was an overwhelming win for sprouts, so—with this deciding factor in mind—sprouts win the day today.
Want to learn more?
You might like to read:
Sprout Your Seeds, Grains, Beans, Etc
Enjoy!
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The Gift Of Aging − by Dr. Elizabeth Eckstrom & Marcy Houle
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This is, as you may gather from the title, a book about getting the most out of growing older, and doing it well.
Not all of it is positive though; some of it really is about avoiding, mitigating, or coping with the negatives that tend to come with aging.
The book is full of many (38) small self-contained chapters, so it’s well-suited to reading bit-by-bit, if so inclined. Essentially, it’s a collection of essays by the two authors, arranged into categories:
- Caring for your mind
- Caring for your body
- Caring for yourself and your family
- Caring for your soul
The first two sections are mostly self-explanatory; the third is largely about estate-planning of various kinds. The fourth is highly subjective, and/but not particularly religious, by the way. It’s largely an add-on to the “caring for your mind” mental health section, but now more specifically dealing with heavy topics such as the emotional side of mortality (as opposed to the previous section’s practical considerations of same), loss, and grief.
The style is the very low end of pop-science; facts (probably true ones; nothing seemed very contentious objectively) are stated with no sources, and there is no medical jargon that’s anything more complicated than you might find on a leaflet in a doctor’s waiting room.
Bottom line: this is a very opinion-filled book, so it’s worth reading with that in mind (i.e. their opinions may differ wildly from yours in some cases), but it’s largely informed opinions, so worth at least considering even in those cases. If nothing else, this book is certainly thought-provoking.
Click here to check out The Gift Of Aging, and enjoy the gift of aging!
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The End of Heart Disease – by Dr. Joel Fuhrman
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We’ve previously reviewed another of Dr. Fuhrman’s books, “Eat To Live”, and this time, he’s focusing specifically on preventing/reversing heart disease.
Dr. Fuhrman takes the stance that our food can either kill or heal us, and we get to choose which. As such, nutrition is central to his heart-healthy plan; he mostly leaves matters of exercise, sleep, etc to other sources.
His dietary approach is mostly uncontroversial: for example, advices include: enjoy nutritionally dense foods, skip processed foods, eat at least mostly plants, skip the added salt. A slightly more controversial aspect is that he advocates for avoiding cooking oils, including the healthiest oils, including olive and avocado, which are by current scientific consensus considered heart-healthy in moderation. As in, not even just heart-neutral, but rather, they actively improve triglycerides.
He compares different cardioprotective diets, and while he’s not unbiased, he does provide 40 pages of scholarly references, so we may understand that at the very least, his approach is sound.
There are also recipes—94 pages of them—for any who might wonder “how do I cook without…?” and some ingredient he would rather you omit.
The style is information-dense (and this is a 448-page book) but still very readable.
Bottom line: if you’re serious about improving your heart health, this book can help a lot with that.
Click here to check out The End Of Heart Disease, and end heart disease for yourself!
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Brain Wash – by Dr. David Perlmutter, Dr. Austin Perlmutter, and Kristen Loberg
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You may be familiar with the lead author of this book, Dr. David Perlmutter, as a big name in the world of preventative healthcare. A lot of his work has focused specifically on carbohydrate metabolism, and he is as associated with grains and he is with brains. This book focuses on the latter.
Dr. Perlmutter et al. take a methodical look at all that is ailing our brains in this modern world, and systematically lay out a plan for improving each aspect.
The advice is far from just dietary, though the chapter on diet takes a clear stance:
❝The food you eat and the beverages you drink change your emotions, your thoughts, and the way you perceive the world❞
The style is explanatory, and the book can be read comfortably as a “sit down and read it cover to cover” book; it’s an enjoyable, informative, and useful read.
Bottom line: if you’d like to give your brain a gentle overhaul, this is the one-stop-shop book to give you the tools to do just that.
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The Kitchen Doctor
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Dr. Rupy Aujla: The Kitchen Doctor
This is Dr. Rupy Aujla, and he’s a medical doctor. He didn’t set out to become a “health influencer”.
But then, a significant heart condition changed his life. Having a stronger motivation to learn more about nutritional medicine, he did a deep dive into the scientific literature, because that’s what you do when your life is on the line, especially if you’re a doctor!
Using what he learned, he was able to reverse his condition using a food and lifestyle approach. Now, he devotes himself to sharing what he learned—and what he continues to learn as he goes along.
One important thing he learned because of what happened to him, was that he hadn’t been paying enough attention to what his body was trying to tell him.
He wants us to know about interoception—which isn’t a Chris Nolan movie. Rather, interoception is the sense of what is going on inside one’s own body.
The counterpart of this is exteroception: our ability to perceive the outside world by means of our various senses.
Interoception is still using the senses, but is sensing internal body sensations. Effectively, the brain interprets and integrates what happens in our organs.
When interoception goes wrong, researchers found, it can lead to a greater likelihood of mental health problems. Having an anxiety disorder, depression, mood disorder, or an eating disorder often comes with difficulties in sensing what is going on inside the body.
Improving our awareness of body cues
Those same researchers suggested therapies and strategies aimed at improving awareness of mind-body connections. For example, mindfulness-based stress reduction, yoga, meditation and movement-based treatments. They could improve awareness of body cues by attending to sensations of breathing, cognitions and other body states.
But where Dr. Aujla puts his focus is “the heart of the home”, the kitchen.
The pleasure of food
❝Eating is not simply ingesting a mixture of nutrients. Otherwise, we would all be eating astronaut food. But food is not only a tool for health. It’s also an important pleasure in life, allowing us to connect to others, the present moment and nature.❞
Dr. Rupy Aujla
Dr. Aujla wants to help shift any idea of a separation between health and pleasure, because he believes in food as a positive route to well-being, joy and health. For him, it starts with self-awareness and acceptance of the sensory pleasures of eating and nourishing our bodies, instead of focusing externally on avoiding perceived temptations.
Most importantly:
We can use the pleasure of food as an ally to healthy eating.
Instead of spending our time and energy fighting the urge to eat unhealthy things that may present a “quick fix” to some cravings but aren’t what our body actually wants, needs, Dr. Aujla advises us to pay just a little more attention, to make sure the body’s real needs are met.
His top tips for such are:
- Create an enjoyable relaxing eating environment
To help cultivate positive emotions around food and signal to the nervous system a shift to food-processing time. Try setting the table with nothing else on it beyond what’s relevant to the dinner, putting away distractions, using your favorite plates, tablecloth, etc.
- Take 3 deep abdominal breaths before eating
To help you relax and ground yourself in the present moment, which in turn is to prepare your digestive system to receive and digest food.
- Pay attention to the way you sit
Take some time to sit comfortably with your feet grounded on the floor, not slouching, to give your stomach space to digest the food.
- Appreciate what it took to bring this food to your plate
Who was involved in the growing process and production, the weather and soil it took to grow the food, and where in the world it came from.
- Enjoy the sensations
When you’re cooking, serving, and eating your food, be attentive to color, texture, aroma and even sound. Taste the individual ingredients and seasonings along the way, when safe and convenient to do so.
- Journal
If you like journaling, you can try adding a mindful eating section to that. Ask questions such as: “how did I feel before, during, and after the meal?”
In closing…
Remember that this is a process, not only on an individual level but as a society too.
Oftentimes it’s hard to eat healthily… We can be given to wonder even “what is healthy, after all?”, and we can be limited by what is available, what is affordable, and what we have time to prepare.
But if we make a conscious commitment to make the best choices we reasonably can as we go along, then small changes can soon add up.
Interested in what kind of recipes Dr. Aujla goes for?
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An RSV vaccine has been approved for people over 60. But what about young children?
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The Therapeutic Goods Administration (TGA) has approved a vaccine against respiratory syncytial virus (RSV) in Australia for the first time. The shot, called Arexvy and manufactured by GSK, will be available by prescription to adults over 60.
RSV is a contagious respiratory virus which causes an illness similar to influenza, most notably in babies and older adults.
So while it will be good to have an RSV vaccine available for older people, where is protection up to for the youngest children?
A bit about RSV
RSV was discovered in chimpanzees with respiratory illness in 1956, and was soon found to be a common cause of illness in humans.
There are two key groups of people we would like to protect from RSV: babies (up to about one year old) and people older than 60.
Babies tend to fill up hospitals during the RSV season in late spring and winter in large numbers, but severe infection requiring admission to intensive care is less common.
In babies and younger children, RSV generally causes a wheezing asthma-like illness (bronchiolitis), but can also cause pneumonia and croup.
Although there are far fewer hospital admissions among older people, they can develop severe disease and die from an infection.
Babies account for the majority of hospitalisations with RSV.
Prostock-studio/ShutterstockRSV vaccines for older people
For older adults, there are actually several RSV vaccines in the pipeline. The recent Australian TGA approval of Arexvy is likely to be the first of several, with other vaccines from Pfizer and Moderna currently in development.
The GSK and Pfizer RSV vaccines are similar. They both contain a small component of the virus, called the pre-fusion protein, that the immune system can recognise.
Both vaccines have been shown to reduce illness from RSV by more than 80% in the first season after vaccination.
In older adults, side effects following Arexvy appear to be similar to other vaccines, with a sore arm and generalised aches and fatigue frequently reported.
Unlike influenza vaccines which are given each year, it is anticipated the RSV vaccine would be a one-off dose, at least at this stage.
Protecting young children from RSV
Younger babies don’t tend to respond well to some vaccines due to their immature immune system. To prevent other diseases, this can be overcome by giving multiple vaccine doses over time. But the highest risk group for RSV are those in the first few months of life.
To protect this youngest age group from the virus, there are two potential strategies available instead of vaccinating the child directly.
The first is to give a vaccine to the mother and rely on the protective antibodies passing to the infant through the placenta. This is similar to how we protect babies by vaccinating pregnant women against influenza and pertussis (whooping cough).
The second is to give antibodies directly to the baby as an injection. With both these strategies, the protection provided is only temporary as antibodies wane over time, but this is sufficient to protect infants through their highest risk period.
Women could be vaccinated during pregnancy to protect their baby in its first months of life.
Image Point Fr/ShutterstockAbrysvo, the Pfizer RSV vaccine, has been trialled in pregnant women. In clinical trials, this vaccine has been shown to reduce illness in infants for up to six months. It has been approved in pregnant women in the United States, but is not yet approved in Australia.
An antibody product called palivizumab has been available for many years, but is only partially effective and extremely expensive, so has only been given to a small number of children at very high risk.
A newer antibody product, nirsevimab, has been shown to be effective in reducing infections and hospitalisations in infants. It was approved by the TGA in November, but it isn’t yet clear how this would be accessed in Australia.
What now?
RSV, like influenza, is a major cause of respiratory illness, and the development of effective vaccines represents a major advance.
While the approval of the first vaccine for older people is an important step, many details are yet to be made available, including the cost and the timing of availability. GSK has indicated its vaccine should be available soon. While the vaccine will initially only be available on private prescription (with the costs paid by the consumer), GSK has applied for it to be made free under the National Immunisation Program.
In the near future, we expect to hear further news about the other vaccines and antibodies to protect those at higher risk from RSV disease, including young children.
Allen Cheng, Professor of Infectious Diseases, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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