Enlightening the Complexity of Maternal Mortality

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Enlightening the Complexity of Maternal Mortality

Isha Gupta
April 2024

About every two minutes, a maternal death occurred in the year 2020, according to the World Health Organization (WHO).^[5]Maternal mortality is a critical global health issue that takes away numerous women’s lives around the world. Data from 2020 reveals that around 95% of all maternal deaths happened in low and lower-middle-income countries, most of which could have been prevented.^[5]Since maternal mortality causes so many deaths worldwide, it is important to unravel the intricacies and be aware of diverse outcomes, factors, and prevention strategies that can influence maternal mortality and save women’s lives.

Maternal mortality is an essential concern to be aware of not only because it takes away so many women’s lives, but it can also directly affect the life course of infants born to mothers who have passed away during and after childbirth. For instance, the infants may not be able to be breastfed and receive the health benefits of breastfeeding as well as lack a maternal figure in their lives. Moreover, the death of a woman during pregnancy or childbirth can drastically affect the lives of her other loved ones. For example, research has found that among previous children of mothers who have died during or after the subsequent pregnancy, their mental health and emotional well-being can be significantly impacted. This, in turn, can also make it more difficult for them to concentrate on academics,^[6]especially when they mourn and grieve the loss of their mother. By the same token, some men who have lost their wives to maternal mortality can be at risk of developing post-traumatic stress disorder.^[6]Maternal death can also bring up concerns about additional child caregiving responsibilities and financial worries^[6]among men whose wives have passed away during pregnancy or childbirth. Therefore, along with posing a threat to women’s lives, maternal mortality can affect men and children to some degree, which is why it is such an important global health concern.

Throughout pregnancy and childbirth, several complications can arise, some of which can lead to maternal mortality. The most common complications leading to maternal mortality include severe bleeding, infections, high blood pressure, and complications from delivery, as well as unsafe abortions.^[5]In order to effectively mitigate such complications as well as other biological and physical health factors leading to maternal mortality, proper medical facilities with trained healthcare workers, medical supplies, access to pharmaceutical drugs, and sanitary services are essential. Women’s lives can also be saved by addressing complications in a time-efficient manner. For example, although a woman experiencing severe bleeding after childbirth can die within hours, medical professionals can help reduce the risk by immediately administering oxytocics after childbirth.^[5]Moreover, the WHO suggests that maternal deaths linked to unsafe abortion can be reduced by providing access to safe abortion services and post-abortion care. Additionally, ensuring access to contraception can help address maternal mortality, by preventing unintended pregnancies.^[5]Furthermore, women who are pregnant^[4]or planning on becoming pregnant^[2]should maintain healthy lifestyles and regularly monitor their health and wellness. Women should be encouraged to continue positive health behaviors, such as eating nutritious food, and eliminate behaviors that can pose a threat to their or their infant’s life, such as substance use.^[2]

Maternal mortality can be complex especially since along with the biological and physical health aspects that can lead to it, numerous and diverse socio-cultural factors can influence it. For instance, in societies where women are considered inferior to men, women’s dietary needs are often ignored. Interestingly, in some cultures, traditionally, the women in a family are able to start eating only after the men and children in the family have finished their meals, as opposed to all members of the family eating together at the same time. Some women cannot access adequate and nutritious food, which is necessary during pregnancy and after childbirth to safeguard their health and prevent complications.^[3]Additionally, exposure to stress and traumatic experiences, including violence, can affect maternal health and well-being. For example, research has shown that intimate partner violence can significantly increase the risk of maternal mortality, especially since it can increase the risk of developing complications such as preterm labor.^[1]Furthermore, since pregnancy and childbirth are so common and natural, women often get ignored or dismissed when they share concerns about them. Research found that especially in societies where pregnant women lack autonomy and mobility, their in-laws decide whether it is worth seeking healthcare, based on components such as the perceived severity of concern, the nature of the threat, and healthcare cost. Many families doubt why they should spend a lot of money on medical facilities when women have given birth in their own homes throughout generations.^[3]As a result, oftentimes, pregnant women are brought to medical facilities when it is too late and they are nearing death due to complications.^[3]

Although pregnancy and childbirth are natural processes that countless women have undergone throughout history for the creation of new lives, it is important to be aware of the diverse factors surrounding maternal mortality and continue advocating for maternal health. Researchers acknowledge that governmental efforts have been made to help provide access to healthcare and basic needs including food, as well as advocating for women’s education and economic empowerment. Nonetheless, awareness^[3]of maternal health should be further raised to promote health literacy and prevent adverse outcomes associated with delays in seeking medical care and complications. Awareness of maternal health should be spread in comprehensive ways and include essential information about the significance of nutritious food, the importance of seeking timely medical care, and effectively caring for women before and after childbirth. The WHO also recognizes the importance of remembering that the health of a pregnant woman directly affects the health and life of both her and her newborn.^[5]Therefore, pregnant women as well as women in the postpartum period should be attentively and responsibly monitored, supported, cared for, and empowered.

References

[1] Agarwal, S., Prasad, R., Mantri, S., Chandrakar, R., Gupta, S., Babhulkar, V., Srivastav, S., Jaiswal, A., & Wanjari, M. B. (2023). A Comprehensive Review of Intimate Partner Violence During Pregnancy and Its Adverse Effects on Maternal and Fetal Health. Cureus, 15(5), e39262. https://doi.org/10.7759/cureus.39262

[2] Centers for Disease Control and Prevention. (2023, April 26). Preventing Pregnancy-Related Deaths. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/preventing-pregnancy-related-deaths .html#:~:text=Many%20factors%20influence%20pregnancy-related,health%20problems%20bef ore%20getting%20pregnant.

[3] Omer, S., Zakar, R., Zakar, M. Z., & Fischer, F. (2021, May 18). The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan. BioMed Central. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01151-6

[4] Stickler, T. (2020, July 9). Maintaining a Healthy Pregnancy. Healthline. https://www.healthline.com/health/pregnancy/healthy-pregnancy

[5] World Health Organization. (2023, February 22). Maternal mortality. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

[6] Zhou, H., Zhang, L., Ye, F., Wang, H. J., Huntington, D., Huang, Y., Wang, A., Liu, S., & Wang, Y. (2016). The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study. PloS one, 11(6), e0157122. https://doi.org/10.1371/journal.pone.0157122

From the Eyes of a Women

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From the Eyes of a Women

Tanvir Bhamra
April 2024

A woman may just be on her way to work, but with each step she takes she navigates through a minefield of double standards. This woman and countless others go through similar experiences of these ridiculous expectations and treatment compared to their male counterparts, as if they’re walking on eggshells. Double standards are far from unknown, and women have protested against them repeatedly; however, many do not know that they are still present.

The gender pay gap started back around the 1800s when it was finally common for women to work; the University of Missouri states in 1840-1841, men were paid $33.81 per month while women were paid 21 dollars less.^[2] This only devalues the time and effort women now put in, as it shows how they are not appreciated with the jarring contrast in wages. Unfortunately, this still continues now, multiple studies have shown that women are paid only 84% of what men are paid, and this is also dependent on their race with Black and Hispanic women getting paid less than men of the same race.^[3]

While walking the streets, women find themselves being cautious to avoid the degrading experience of catcalling, where a stranger makes inappropriate or suggestive comments about their appearance. Despite it being a clear form of harassment, women are expected to tolerate such behavior and are mocked for speaking out against it. The normalization of this not only violates a woman’s dignity but also contributes to other women’s feelings of discomfort and fear.

These double standards also exist in parenting, beginning with the expectation that women should stay at home with the kids. Meanwhile, fathers pay no attention. These ideas continue to influence present-day norms for the division of domestic labor. While mothers have the majority of childcare responsibilities, fathers are praised for performing even the most basic tasks. To add on, when fathers take care of their kids, others will call it “babysitting.” This can be infuriating for both parents as the father is just carrying out his responsibilities while everyone expects the mother to go above and beyond with childcare, sometimes ridiculing her if she gets “lazy.” This only places a burden on women and hinders the importance of fatherhood.^[1]

Besides the expectations of parents, double standards even affect how parents treat their children; it is often shown that fathers are way more protective and strict with their daughters, giving them early curfews, forbidding them from dating, monitoring the clothes they wear, and more. Even my father brings up the idea of me having children in the future, even though I’m not fond of kids. I notice that these comments are not directed at my brother, only mentioning that he’ll find a nice woman in the future. Fortunately, my father is not as strict with me on other matters, like curfews and diet, but he certainly treats me differently from my brother, though this is affected by age as well.

In the midst of all of this, women feel pressured to fit into unrealistic beauty standards. For instance, having a shaved body has been very normalized in women. Many times in public I’ve made sure my underarm hair wasn’t showing in fear of dirty looks and judgment, a concern not present in the minds of men. Additionally, women face criticism and harsh comments for exhibiting characteristics considered to be “manly” such as having body hair or a smaller chest. A study from the National Library of Medicine says, “The results indicate that men devalue non-ideal bodies and upvalue ideal bodies when they are self-related, whereas women rate in a fair-minded manner. Thus, in contrast to women, an advantage for men may be that they can self-enhance in the case of desirable bodies.”^[4] In simpler terms, this talks about how men tend to devalue bodies that don’t match their ideal standards to boost their confidence; on the other hand, women judge bodies overall regardless of whether they match; possibly because of the many beauty standards pushed onto them.

Noticing these situations in my day-to-day life has proven that these double standards have never disappeared and have been integrated into our culture and minds such that many don’t notice. In fact, women now hold men to high standards of being their partners, some more reasonable than others such as simply treating them with respect since it’s not shown as often. Either way, we need an environment where all individuals, regardless of gender, can thrive and flourish, and release ourselves from double standards.

References

[1] Ciletti, N. (2024, April 3). Gendered Double Standards In Parenting: Five Strategies To Help Promote Fairness. BetterHelp. Retrieved April 29, 2024, from https://www.betterhelp.com/advice/parenting/gendered-double-standards-in-parenting-5-strategies-to-help-promote-fairness/

[2] 1840-1849 – Prices and Wages by Decade. (2024, April 4). Library Guides. Retrieved April 12, 2024, from https://libraryguides.missouri.edu/pricesandwages/1840-1849

[3] George, E., & Livingston, G. (2024, March 12). What You Need to Know About the Gender Wage Gap. DOL Blog. Retrieved April 7, 2024, from https://blog.dol.gov/2024/03/12/what-you-need-to-know-about-the-gender-wage-gap

[4] Giving a Body a Different Face—How Men and Women Evaluate Their Own Body vs. That of Others. (2022, May 2). NCBI. Retrieved April 7, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9108869/

Silent Killers: The Lethal Consequences of Health Misinformation

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Silent Killers: The Lethal Consequences of Health Misinformation

Roma Bhavsar
April 2024

What is Misinformation?

Misinformation is defined as information that is inaccurate, misleading, or false and deliberately intended to deceive.^[1,2]According to the current Surgeon General of the United States, Dr. Vivek Murthy, “health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts.” A dire consequence of health misinformation can lead individuals to decline vaccines or essential medicines, ignore public health measures, and consume unproven treatments that pose potential harm when ingested.^[2]

Navigating Reliable Sources in the Social Media Era

In the past decade, an increasing number of people began to rely on social media for their news. Although convenient, accessing information online poses significant challenges because not all content is reliable, leading to the rapid spread of misinformation.

One of the biggest ways to avoid getting wrong information is to make sure you are getting facts from credible, reputable, and cited sources. From a health perspective, this could be a peer-reviewed medical journal (The New England Journal of Medicine, The Lancet, etc.) or educational website (.gov and .edu), a health organization such as Mayo Clinic, or a reputable online newspaper.^[3]Misinformation is detrimental to society and can lead to increased fatalities and exacerbated public health crises; ultimately endangering the lives of our loved ones and people within our communities.

Identifying the most vulnerable individuals to misinformation allows for targeted allocation of resources and attention to those who are most susceptible. Certain demographics, including the elderly, young individuals, frequent social media users, and those with limited formal education, are particularly vulnerable to misinformation. Additionally, individuals with strong political affiliations are more inclined to believe information aligning with their existing biases, especially when it originates from trusted sources. This highlights the critical concern surrounding the dissemination of misinformation among susceptible populations.^[4]

Decreasing the Burden of Misinformation

Unfortunately, the vast amount of healthcare misinformation has significantly influenced how and where people look to consume information, often leading to a lack of verification of its authenticity.

There are numerous solutions to mitigate the impact of misinformation. A collaborative approach involving governments, health entities, technology firms, social media, and the public is essential. Governments must rebuild trust by delivering clear, frequent messages and demonstrating transparency in decision-making processes. Identifying vulnerable populations and factors contributing to susceptibility is crucial for targeted interventions. Governments should collaborate with health organizations to create platforms that easily disseminate evidence based information. Social media companies need to enhance surveillance of their platforms and create frameworks for removing false data. Phone apps providing up-to-date scientific data and government recommendations can help combat misinformation effectively.^[3]Lastly, creating awareness campaigns, implementing legal policies, and enhancing health literacy are additional strategies that can be executed.^[1]

During the COVID-19 pandemic, it was evident that healthcare misinformation had significantly influenced public behavior. Social media was a driving force in misinformation spreading and a way to mitigate this risk is increased monitoring of websites to remove incorrect information, using algorithms and software to comb through and fact check data, and working more closely with evidence-based, peer-reviewed medical journals.^[3]

What Does This All Mean?

Misinformation about the COVID-19 virus’s spread has made people less cautious in recent years. Moreover, doubts about vaccine safety, fueled by false claims, have led to widespread hesitancy. This highlights the need for trustworthy health information and vigilant monitoring of social media. To tackle this “infodemic,” collaboration among governments, scientists, social media companies, and community organizations is vital.^[3]

Those who share information publicly, particularly healthcare professionals who are seen as scientific subject matter experts, have a moral duty to ensure the information they share is sourced from reputable sources. Given their influence, their words can profoundly shape public perception and behavior.^[4]

Enhancing the quality of health information we consume has widespread benefits, enabling us to make informed decisions for ourselves, our families, and our communities while mitigating the spread of misinformation.^[2]

References

[1] World Health Organization. (2022, September 1). Infodemics and Misinformation Negatively Affect People’s Health Behaviours. www.who.int.

https://www.who.int/europe/news/item/01-09-2022-infodemics-and-misinformation negatively-affect-people-s-health-behaviours–new-who-review-finds

[2] Health Misinformation — Current Priorities of the U.S. Surgeon General. (n.d.). www.hhs.gov. https://www.hhs.gov/surgeongeneral/priorities/health

misinformation/index.html#understand

[3] Ferreira Caceres, M. M., Sosa, J. P., Lawrence, J. A., Sestacovschi, C., Tidd-Johnson, A., Rasool, M. H. U., Gadamidi, V. K., Ozair, S., Pandav, K., Cuevas-Lou, C., Parrish, M., Rodriguez, I., & Fernandez, J. P. (2022). The Impact of Misinformation on the COVID-19 Pandemic. AIMS Public Health, 9(2), 262–277. https://doi.org/10.3934/publichealth.2022018

[4] Nelson, T., Kagan, N., Critchlow, C., Hillard, A., & Hsu, A. (n.d.). the Danger of Misinformation in the Covid-19 Crisis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721433/pdf/ms117_p510.pdf

PCOS: Can It Affect Brain Function?

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PCOS: Can It Affect Brain Function?

Rachel Marti
April 2024

Whether this is the first time you are hearing about polycystic ovary syndrome (PCOS) or not, the name of this disorder may mislead you into thinking that it is caused explicitly by having several ovarian cysts, but that is not entirely true^[12]. The National Library of Medicine defines PCOS as an endocrine disorder that involves having two or more of these three determining factors: irregular menses, hyperandrogenism, and polycystic ovaries^[3,6]. Currently, the cause of PCOS in women of reproductive ages (18-40 years old) is still unknown^[3,4]. But, scientists believe that perhaps hereditary genes, environmental factors, hormonal imbalances, and/or insulin resistance may play a role in developing PCOS^[3,4]. Since there is no known cure, the disorder is currently being managed via medications and lifestyle modifications in an attempt to alleviate its symptoms^[3,14,15].

PCOS in Everyday Life

PCOS is accompanied by several unpleasant symptoms such as weight gain, pelvic pain, headaches, acne, edema, decreased libido, mood swings, etc ^[9,14,15]. PCOS significantly affects a woman’s quality of life as it is one of the leading causes of infertility^[11,14,15]. Various combinations of the three previously mentioned PCOS factors can cause an overexpression of androgens, such as testosterone^[4,15]. This can prohibit ovulation, and therefore fertilization, from occurring^[4,15]. Infertility can also cause major psychological distress as becoming a mother is a future many women look forward to^[15]. Not only does this affect the PCOS patient, but it can affect the relationship with their partner and/or family members^[15]. This can cause feelings of unworthiness, guilt, and barrenness which may lead to anxiety and depression^[11]. Couples battling PCOS-related infertility may try certain medications and/or fertility treatments in order to achieve stable hormone levels and increase their chances of egg fertilization. This can be a time-consuming and mentally draining process as one’s rate of success with these methods is not always guaranteed^[10,11].

The aforementioned high levels of testosterone and other androgenic hormones frequently lead to hirsutism in women suffering with PCOS^[4,15]. This condition causes excessive hair growth on parts of the body such as the face, chest, legs, back, or arms^[4,15,16]. It can be a debilitating condition, especially for young women, who are often judged by others, and made to feel abnormal, ashamed, and less feminine^[4,15,16]. Although there are hair reduction options, removing the hair professionally usually takes multiple sessions in order to see results and the process can be painful^[16]. Not only does this require time and money, but keeping the condition hidden is stressful as well^[15,16]. In summary, living with PCOS can cause women to feel social stigma, anxiety, and depression, they may also create a negative body image of themselves^[13].

Diagnostic Dilemma

Despite PCOS being deemed a medical disorder over 100 years ago, up to 70% of affected women remain undiagnosed worldwide^[1,2,7]. But, why is that? Physicians face a challenge when it comes to diagnosing PCOS because of one thing: the symptoms. PCOS can present itself through many symptoms that overlap and mimic what you would commonly find in other diseases such as pelvic inflammatory disease, thyroid disease, diabetes, etc^[5,7,8]. Therefore, physicians request certain lab tests to be conducted and from their results, they eliminate other similar diseases; it could take several months or years for a true PCOS diagnosis to be reached^[1]. This period of time where the patient is waiting to be diagnosed could potentially allow other harmful, long-term complications associated with PCOS to develop such as obesity, type 2 diabetes mellitus (DM-2), depression, endometrial cancer, and nonalcoholic fatty liver disease^[1,8,15]. On a similar note, PCOS has also been found to increase one’s risk of heart disease and metabolic disorders. Recently, scientists have also discovered that it may also increase one’s risk of memory loss^[2,5].

A New Study Relating Brain Health and PCOS, Results Discussed

An ongoing cohort study conducted by CARDIA Women’s health has collected new data that suggests PCOS may have negative impacts on the brain^[5]. Approximately one thousand women participated in this study, with roughly 6% of those women having PCOS per the study’s definition of PCOS^[5]. The participants partook in a variety of cognitive tests that measured brain memory, reaction time/attention capacity, and verbal fluency^[5]. In addition, a subset of the participants had brain MRI’s conducted in order to observe any differences between PCOS vs. non-PCOS participants^[5].

The results of the study show that the PCOS patients, in fact, did score lower on the cognitive tests compared to the participants without PCOS. In addition, PCOS patients exhibited decreased white matter density in their brains^[5]. White matter is the portion of your brain that is responsible for memory retention and coordination^[17]. However, this study is unable to conclusively state that there is a significant decrease in brain function directly caused by PCOS^[5].

Most published PCOS studies focus on its relation to heart health and infertility, but this is the first study that has attempted to observe a direct correlation between brain health and PCOS in women of middle age; with these new findings come a few caveats^[5]. One limitation from this experiment is that the group size is not very large; the number of participants for both the cognitive testing and the MRI testing was relatively small^[5]. A larger group of participants would yield a more accurate dataset and give us a greater understanding of the toll this disorder can take on the brain. Regarding the brain MRI results, further research is needed to verify whether or not the decrease in cognitive performance is directly related to PCOS or simply a consequence of aging^[5]. Scientists should consider looking into certain metabolic and hormonal factors that can affect the brain as well as the current mental state of the PCOS patients. For example, depression is a common PCOS symptom which is known to decrease brain function^[5]. Although performing this study was a huge step in the right direction, more research must be conducted. If future research provides evidence to support this study, it should primarily focus on preventing or slowing the rate of memory loss for affected women^[2]. This could greatly improve the quality of life for PCOS patients as it may allow us to gain more insight into the mysteriously complex inner workings of this disorder^[2].

References:

[1] Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. (2022). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK459251

[2] Daye, J. (2024). PCOS, a painful condition for millions of women, linked to memory loss, study finds. Miami Herald. Retrieved from https://www.miamiherald.com/news/nation-world/national/article284977342.html

[3] John Hopkins Medicine.(n.d). Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,that%20form%20in%20the%2 0ovaries.

[4] Cleveland Clinic. (2023). https://my.clevelandclinic.org/health/diseases/24639-hyperandrogenism

[5] Huddleston, H.G., Jaswa, E.G., Casaletto, K.B., Neuhaus, J. , Kim, C. Wellons, etc. (2024). Associations of Polycystic Ovary Syndrome WithIndicators of Brain Health at Midlife in the CARDIA Cohort. Neurology 2024. https://www.neurology.org/doi/abs/10.1212/WNL.0000000000208104. doi:10.1212/WNL.0000000000208104

[6] Dennett, C. C., & Simon, J. (2015). The role of polycystic ovary syndrome in reproductive and metabolic health: overview and approaches for treatment. Diabetes spectrum : a publication of the American Diabetes Association, 28(2), 116–120. https://doi.org/10.2337/diaspect.28.2.116

[7] World Health Organization. (n.d.). Polycystic ovary syndrome.

https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome#:~:text=Polycysti c%20ovary%20syndrome%20(PCOS)%20affects,affected%20women%20remain%20undiagnos ed%20worldwide

[8] Sirmans, S. M., & Pate, K. A. (2013). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology, 6, 1–13. https://doi.org/10.2147/CLEP.S37559

[9] Bromberger, A. (2022). Why Women Face Difficulties Receiving PCOS Diagnosis. Duke University.https://dukecenterforglobalreproductivehealth.org/2022/12/26/why-women-face-diffic ulty-receiving-pcos-diagnoses/

[10] Melo, A. S., Ferriani, R. A., & Navarro, P. A. (2015). Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo, Brazil), 70(11), 765–769. https://doi.org/10.6061/clinics/2015(11)09

[11] Sharma A, Shrivastava D. Psychological Problems Related to Infertility. Cureus. 2022 Oct 15;14(10):e30320. doi: 10.7759/cureus.30320. PMID: 36407201; PMCID: PMC9661871.

[12] Azziz R. Polycystic ovary syndrome: what’s in a name? J Clin Endocrinol Metab. 2014 Apr;99(4):1142-5. doi: 10.1210/jc.2013-3996. Epub 2014 Feb 3. PMID: 24491161; PMCID: PMC3973784.

[13] World Health Organization. (28 June 2023). https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

[14] Divya, M., & Ranganathan, S. (2022). “PCOS is Like Having a Disease”: The Everyday Stress of Living with Polycystic Ovarian Syndrome (PCOS). Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 47(4), 622–623. https://doi.org/10.4103/ijcm.ijcm_1374_21

[15] Brady, C., Mousa, S. S., & Mousa, S. A. (2009). Polycystic ovary syndrome and its impact on women’s quality of life: More than just an endocrine disorder. Drug, healthcare and patient safety, 1, 9–15. https://doi.org/10.2147/dhps.s4388

[16] PCOS Awareness Association. (n.d.) PCOS AND UNWANTED FACIAL HAIR. https://www.pcosaa.org/pcos-and-unwanted-hair

[17] University of North Carolina.(2021). White matter plays a complex role in brain health. https://sph.unc.edu/sph-news/white-matter-plays-a-complex-role-in-brain-health/#:~:text=While %20gray%20matter%20is%20a,and%20stay%20balanced%20when%20walking.

Mothers First, Women Second: Childfree Women’s Fight for Sterilization

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Mothers First, Women Second: Childfree Women’s Fight for Sterilization

Lisa Samy
April 2024

For a woman to decide to be childfree—meaning to not have children—they are chained to a never-ending struggle for bodily autonomy. In particular, when it comes to the fight for permanent sterilization. Sue, a childfree woman living in Queensland, Australia, had long suffered uncomfortable side effects from hormonal contraception.^[1]Yet, her doctor refused to consider her request for permanent sterilization, and “treated [her] very condescendingly,” leaving her with “long-lasting trauma.”^[1]

Surely if women are old enough to have children, then they are old enough to choose not to have them as well. As of now, many people believe this isn’t the case.

Don’t Want Children? Prepare to get “Bingoed”

Rising inflation, living costs, climate change, and stricter anti-abortion legislations ( the reversal of Roe v. Wade) have solidified an increasing number of young women’s choice to be childfree.^[4] Still, there are women who don’t wish to have children simply because they don’t feel “that calling” to be a mother.^[4]Any and all reasons should be treated as enough, but society’s overwhelmingly pronatalist views and enforced gender roles bar its validation.

Therefore, childfree women are lambasted with negative and presumptuous comments about their decision, even from friends and family. One of the largest online childfree communities—the r/childfree subreddit on the platform Reddit—has labeled these remarks as “bingos.”^[2]Some notable bingos are “you’ll change your mind,” “don’t worry, you’ll find the one someday” or “so, you just sleep around then?”^[2] In short, their choices aren’t taken seriously and reduced to a phase.

The Hard-fought Battle for Sterilization

The main reason doctors deny sterilization requests to child-free women are their potential regret for their decision.^[3]However, studies show that post sterilization regret for women is merely “20.3 percent of those 30 or younger and 5.9 percent of those over 30.”^[3]Regardless, the world constantly equates motherhood to womanhood, forcing childfree women into a status of perceived inferiority. They are stereotyped as selfish and immature, shirking from their duty to reproduce, and regarded with a less rewarding life compared to women with children.^[3]

On the other hand, childfree men don’t deal with nearly as much backlash. Fatherhood is associated as a learned skill rather than an intrinsic one—as in, separate to a man’s biological makeup.^[3]Furthermore, studies indicating the sterilization regret for childfree men are sparse, cementing that men aren’t held up to the same level of scrutiny.^[3]As such, sexism creates a division between childfree men and childfree women’s experiences.

In fact, childfree women with partners have attested to this disparity. Jess Lawry, a military spouse, says her husband was able to receive a vasectomy with little to no pushback from doctors.^[4] It’s a stark contrast compared to her journey for a tubal ligation: one of countless attempts, ending with no approval for sterilization.^[4]

Opening the Doors to Communication

Women are slowly realizing that having children isn’t an obligation—it’s a choice. Those who do opt to be childfree hope to have candid discussions with their friends and family one day, but fear the derisive remarks they may receive.^[1]When people let go of gendered prejudices, it opens a much needed path for childfree women to find support from loved ones, and access birth control that caters to their needs.

References:

[1] Davey, Melissa. (2021). ‘Why is it such a scandalous thing?’: the women who have to fight for their right to be child-free. The Guardian. https://www.theguardian.com/society/2021/jan/08/why-is-it-such-a-scandalous-thing-the-women -who-have-to-fight-for-their-right-to-be-child-free

[2] Hintz A., Elizabeth & Brown L., Clinton. (2019). Childfree and “bingoed”: A relational dialectics theory analysis of meaning creation in online narratives about voluntary childlessness. Communication Monographs. (2019). https://www.marshall.edu/commstu/files/Monographs_Childfree-and-bingoed_-A-relational-dial ectics-theory-analysis-of-meaning-creation-in-online-narratives-about-voluntary-childlessness.pdf

[3] Lalonde, Dianne. (2018). Sexist barriers block women’s choice to be sterilized. The Conversation. https://theconversation.com/sexist-barriers-block-womens-choice-to-be-sterilized-99754

[4] Sweeney, Britney. (2022). The rise of childfree Gen-Z: As demand for female STERILIZATION for under-30s soars, ‘childless-by-choice’ women speak out about their decision and the bitter struggles they’ve faced – from doctors REFUSING surgeries to shock $28K bill. Daily Mail. https://www.dailymail.co.uk/news/article-11051355/Gen-Z-women-sterilized-speak-decision.htm

The Miraculous Journey of Labor and Delivery

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The Miraculous Journey of Labor and Delivery

Rebecca Johnson
April 2024

For many young women, the thought of labor and delivery has always been daunting…but the journey is truly astounding, and is separated into multiple stages till birth. The technical term for childbirth is “Parturition”, which is calculated to be 280 days from a woman’s last menstrual period. Now, we are going to walk through each stage and dive deeper into this interesting topic. The definition of labor is the series of events that expel the infant from the birth giver. The whole experience is extremely terrifying, especially if the woman experiences Braxton- Hicks contractions, which are false uterine contractions caused by the peaking of estrogen. The peak of estrogen increases the amount of oxytocin receptors, which inhibits progesterone from calming the uterine muscle during the birth process.

Stage 1: Dilation

The first stage is the dilation stage. During this time, the cervix is 8-10 cm and is fully dilated in 8 to 18 hours. In subsequent pregnancies, the time to full dilation decreases to 5-12 hours. At the end of this stage, the mother will feel the urge to push.^[1] This stage creates true contractions, but only until the cervix is fully dilated. At this time, the baby’s head will be pushed against the cervix, and water breaks as the amnion ruptures. Amnion is the inner membrane that surrounds the embryo^[2] During pregnancy, the amniotic fluid, which fills the amniotic sac, protects the fetus from injury and temperature changes such as maintaining heat. Since it is soft, it allows the fetus to move freely and assists with musculoskeletal development, lung development, and pressure on the umbilical cord^[.4] There are many hormones and chemicals working behind the scenes to make this happen. For example, atural and synthetic prostaglandins help relax cervical muscles to soften the cervix, which makes it easier to dilate.^[3]

Stage 2: Expulsion

By the second stage, the cervix will have been fully dilated and prepared for childbirth. Now, it is time for the woman to start pushing her baby out. Although the amount of time this takes will vary with every birth, it typically lasts from 20 minutes to a few hours. This time period will decrease with the second child, and so on.^[5] This time is also ideal to get an epidural, because it cannot be given right before the mother gives birth, but must be fully dilated. However, an epidural can be given any time the mother can remain relatively still.^[6] The purpose of an epidural is to relieve any intense pain the mother feels while pushing. An epidural can be a steroid or an anesthetic, injected into your spinal nerves.^[7] A catheter is the tube that injects the medicine into the spine, as a small tube.^[8]

Stage 3: Placental stage

The uterine contractions will continue for about 15 minutes after birth, the placenta detaches from the uterine wall. After it detaches, the doctor will pull the umbilical cord which removes the placenta. During birth, the placenta, a temporary organ, attaches to the uterus, and helps pass oxygen, nutrients, and antibodies from the mother to the baby, while getting rid of wastes from the baby. In the case of twins, identical twins may share a placenta, but fraternal twins have their own placentas.^[9]

Reference

^[1]The stages of labour and birth. (2020, December 1). Nhs.uk. https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/#:~:text=Your%20cervix%20needs%20to%20open

^[2] Redirect Notice. (n.d.). Www.google.com. Retrieved April 12, 2024, from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142%23:~:text%3DDuring%2520pregnancy%252C%2520your%2520baby%2520is

^[3]Redirect Notice. (n.d.). Www.google.com. Retrieved April 12, 2024, from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://my.clevelandclinic.org/health/treatments/22165-cervical-ripening%23:~:text%3DProstaglandins%2520are%2520naturally%2520occurring%2520chemicals

^[4] Amniotic fluid Information | Mount Sinai – New York. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/special-topic/amniotic-fluid#:~:text=Amniotic%20fluid%20surrounds%20the%20growing

^[5]Stages of labor. (n.d.). Www.marchofdimes.org. https://www.marchofdimes.org/find-support/topics/birth/stageslabor#:~:text=In%20the%20second%20stage%20of%20labor%2C%20your%20cervix%20is%20fully

^[6] “Redirect Notice.” www.google.com/urlsa=t&source=web&rct=j&opi=89978449&url=www.yalemedicine.org/news/epidural-anesthesia%23:~:text%3DA%2520woman%2520can%2520get%2520an. Accessed 26 Apr. 2024.

^[7]Cleveland Clinic. (2021, October 14). Epidural: What It Is, Procedure, Risks & Side Effects. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/21896-epidural

^[8] Redirect Notice. (n.d.). Www.google.com. Retrieved April 12, 2024, from https://www.google.com/urlsa=t&source=web&rct=j&opi=89978449&url=https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx%3Fhwid%3Dzc2342%23:~:text%3DYou%2520will%2520get%2520a%2520shot

^[9]Australia, H. (2023, February 8). About the placenta – role and complications. Www.pregnancybirthbaby.org.au. https://www.pregnancybirthbaby.org.au/about-the-placenta#:~:text=mum%20and%20baby.-

Understanding PCOS: Risks and Changes Over the Ages

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Understanding PCOS: Risks and Changes Over the Ages

Emily Bergin

April 2024

Background

Polycystic ovary syndrome (PCOS) impacts approximately 10% of females and is a lifelong condition.^[1] It can be diagnosed in adolescence but often goes unrecognized for some time with the mean age of cases around 27 years of age.^[2]Despite being an endocrine condition, it is associated with a host of other risks and comorbidities.

Correlated Conditions

Patients with PCOS often struggle with additional conditions such as obesity, metabolic syndrome, and diabetes.^[2]All these conditions can increase individuals’ risk of developing PCOS. Therefore it is important to target preventing excessive weight gain and insulin resistance early in life to reduce the risk.^[2]Insulin resistance in particular is highly prevalent and experienced by 50-95% of general and obese PCOS women.^[3]

Due to the correlation with weight gain and metabolic conditions, there is a need to better understand how disordered eating may be related to PCOS. In a study of 46 PCOS patients and 56 controls, binge eating symptoms were found to be more prevalent in the PCOS group.^[4] Symptoms including uncontrolled, emotional, and binge eating were observed as positively correlated, highlighting the need to further investigate this association to reduce PCOS risk and associated comorbidities.

Changes Over the Years

In addition to the concerns highlighted above, PCOS is also associated with other eating disorders and body image concerns. PCOS is associated with risks of infertility and sleep issues as well.^[1]Since this is a lifelong condition, concerns tend to change over the course of time depending on the individual’s age. Younger patients tend to be more concerned over increased risks of dermatological issues like acne, irregular periods, and body image. As they age into the family planning stage of life, fertility troubles and the development of cardiac diseases become more relevant and important.^[1]

It is important to not only be aware of the symptoms of PCOS to help with early diagnosis but also to better understand how this chronic condition affects all aspects of life. With the right approach, including healthier lifestyle changes and seeking medical help where need be, PCOS can be a well-managed disease that does not have to negatively impact women’s overall health and well-being.

References

[1] Simon, S. L., Phimphasone-Brady, P., McKenney, K. M., Gulley, L. D., Bonny, A. E., Moore, J. M., Torres-Zegarra, C., & Cree, M. G. (2024). Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood. The Lancet. Child & adolescent health, S2352-4642(24)00019-1. Advance online publication. https://doi.org/10.1016/S2352-4642(24)00019-1

[2] Christ, J. P., Yu, O., Barton, B., Schulze-Rath, R., Grafton, J., Cronkite, D., Covey, J., Kelley, A., Holden, E., Hilpert, J., Sacher, F., Micks, E., & Reed, S. D. (2024). Risk Factors for Incident Polycystic Ovary Syndrome Diagnosis. Journal of women’s health (2002), 10.1089/jwh.2023.0741. Advance online publication. https://doi.org/10.1089/jwh.2023.0741

[3] Dubey, P., Reddy, S., Sharma, K., Johnson, S., Hardy, G., & Dwivedi, A. K. (2024). Polycystic Ovary Syndrome, Insulin Resistance, and Cardiovascular Disease. Current cardiology reports, 10.1007/s11886-024-02050-5. Advance online publication. https://doi.org/10.1007/s11886-024-02050-5

[4] Pehlivanturk-Kizilkan, M., Akgül, S., Güven, A. G., Düzçeker, Y., Derman, O., & Kanbur, N. (2024). Binge eating symptomatology in adolescents with polycystic ovary syndrome. Physiology & behavior, 279, 114532. Advance online publication. https://doi.org/10.1016/j.physbeh.2024.114532

The Loneliness Epidemic and What the World is Doing to Fight It

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The Loneliness Epidemic and What the World is Doing to Fight It

Paz Etcheverry, MS, PhD

April 2024

The loneliness epidemic has been touted as an epidemic of modern societies. According to Dr. Vivek Murthy, the current Surgeon General of the United States, more than half of American adults are lonely.^[9]Globally, it has been estimated that 1 in 4 older people experience social isolation and between 5 and 15 percent of adolescents experience loneliness.^[20]

Loneliness is a feeling that may arise at certain moments in life and affects anyone, regardless of gender, age, or socio-demographic characteristics.^[22]Loneliness is synonymous with perceived social isolation, not with objective social isolation. In other words, people can live relatively solitary lives and not feel lonely. Conversely, people can lead a seemingly rich social life and feel lonely.^[10] Loneliness is a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or quality of one’s social relationships.^[10]

Causes of Loneliness

There are numerous root causes of loneliness such as lack of social skills, disagreeableness, and antisocial behavioral tendencies. For example, less agreeable adolescents are more likely to report a chronically high level of loneliness.^[6]Social media might also be to blame.^[6]A study found that the more time spent on social media, the greater the risk of loneliness overall, especially for people who used social media as a means for maintaining relationships.^[3]We have become less trustworthy of others, which contributes to social isolation and loneliness.^{[2] [18] [21]} Living alone, the loss of family or friends, chronic illnesses, long-term disabilities, going through changes such as the loss of a job or divorce, sensory impairments, and psychiatric or depressive disorders might cause or exacerbate social isolation or loneliness.^{[4] [16]}

Effects of Loneliness on Health

Loneliness can impact both physical and mental well-being. Higher risk of heart disease, lung disease, cardiovascular disease, hypertension, atherosclerosis, stroke, and metabolic disorders, such as obesity and metabolic disease, have all been associated with loneliness.^[22] In fact, loneliness increases the likelihood of early death by 26 percent—an increase roughly equivalent to smoking 15 cigarettes a day. Loneliness has been associated with an increased risk of depression, psychosis, mental disorders, anxiety, stress, and suicide.^{[12] [14] [22]}

What the World is Doing to Fight Loneliness

In light of this epidemic and its insidious effects, governments and companies alike are attempting to tackle loneliness. Here are a few examples.

In 2018, the UK appointed its first Loneliness Ministry to develop and support innovative anti-loneliness programs.^[11]

The National Health Service of the UK has funded social prescribing, an approach where doctors can refer their patients to activities, groups, and services in their community,^[9] such as pottery classes, language courses, dance, and cooking lessons to name a few.

The Know Your Neighbourhood Fund, launched by the UK government in January 2023, is a £30-million funding initiative aimed at increasing community participation and addressing loneliness in 27 disadvantaged areas across England. The fund focuses on supporting individuals in these areas to connect through volunteering, enhancing their well-being.^[5]

Japan’s Prime Minister appointed a Minister of Loneliness in 2021 to address the rising issues of loneliness, social isolation, and increased suicide rates exacerbated by COVID-19 restrictions, which have mainly affected women and the elderly.^[17]

In 2023, New York Governor Kathy Hochul appointed 95-year-old media personality and sex therapist Dr. Ruth, also known as Ruth Westheimer, as the state’s Loneliness Ambassador to address the growing issue of loneliness.^[19]

That same year, Australia launched its first ever Loneliness Awareness Week (7 through 11 August), which aims to raise awareness about loneliness and its impact on mental and physical health and to encourage individuals and communities to take action to reduce loneliness and increase social connections.^[13]

In response to reports of over a million people in South Korea living as recluses due to the coronavirus scare, the government has introduced a monthly living allowance of US $490 for lonely youths to encourage them to leave their homes.^[1]

It is not only governments that take action when it comes to fighting loneliness. The Dutch grocery store chain Jumbo has created slow “chat checkout” lanes where cashiers take time to talk with people. Additionally, Jumbo has created “chat corners” where people can enjoy coffee and small talk.^[15]

In Ireland, Friends of the Elderly, established in 1980 as a volunteer-based charity, is dedicated to combating loneliness among older individuals living alone. With a small staff and committed volunteers, the organization provides emotional and social support to improve the lives of older members, promoting independence and a sense of community connection.^[8]

Ventilen, which translates to “friend to one” in Danish, is a two-decade-old initiative designed to unite individuals aged 15 to 25 in Denmark. Organized twice a week, the program pairs 2 or 3 volunteers with the participants. Within the group, activities such as playing games, preparing meals, attending cinema outings, and fostering essential human connections take place, addressing the sense of connection that many in this age group may be seeking.^[7]

In conclusion, the global battle against the loneliness epidemic is gaining momentum, with various nations implementing strategies to address this pervasive issue. From government to community-based initiatives fostering social connections, the world is actively seeking solutions to combat loneliness.

References

[1] Awasthi, A. (2023). ‘Hikikomori’: South Korea paying its ‘lonely’ youth to go out and socialise. https://www.firstpost.com/world/hikikomori-south-korea-paying-its-lonely-youth-to-go-out-a nd-socialise-12449452.html

[2] Barjaková, M., Garnero, A., & d’Hombres, B. (2023). Risk factors for loneliness: A literature review. Social science & medicine (1982), 334, 116163. https://doi.org/10.1016/j.socscimed.2023.116163

[3] Bonsaksen, T., Ruffolo, M., Price, D., Leung, J., Thygesen, H., Lamph, G., Kabelenga, I., & Geirdal, A. Ø. (2023). Associations between social media use and loneliness in a cross-national population: do motives for social media use matter? Health Psychology and Behavioral Medicine,11(1), 2158089. https://doi.org/10.1080/21642850.2022.2158089

[4] Center for Disease Control and Prevention (2023). Health Risks of Social Isolation and Loneliness. https://www.cdc.gov/emotional-wellbeing/social-connectedness/loneliness.htm

[5] Department of Culture, Media and Sport (2023). About the Know Your Neighbourhood Fund. https://www.gov.uk/guidance/about-the-know-your-neighbourhood-fund

[6] Dibb, B., & Foster, M. (2021). Loneliness and Facebook use: the role of social comparison and rumination. Heliyon, 7(1), e05999. https://doi.org/10.1016/j.heliyon.2021.e05999

[7] Dr. Happy (2023). A simple way to combat loneliness; lessons from the Danes. https://drhappy.com.au/2019/04/23/a-simple-way-to-combat-loneliness-lessons-from-the-dan es/

[8] Friends of the Elderly Ireland (n.d.). Bringing Friendship and Companionship. https://friendsoftheelderly.ie/about/

[9] Global Wellness Summit (2023). Governments Ramp Up the War on Loneliness. https://www.globalwellnesssummit.com/blog/governments-ramp-up-the-war-on-loneliness/

[10] Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 40(2), 218–227. https://doi.org/10.1007/s12160-010-9210-8

[11] John, T. (2018). How the World’s First Loneliness Minister Will Tackle ‘the Sad Reality of Modern Life’.https://time.com/5248016/tracey-crouch-uk-loneliness-minister/

[12] King, M. (2018). Working to address the loneliness epidemic: perspective-taking, presence, and self-disclosure. American Journal of Health Promotion, 32(5),1315–1317. doi:10.1177/0890117118776735c

[13] Loneliness Awareness Week (2023). Lonely, not Alone. https://lonelinessawarenessweek.com.au/

[14] Mann, F., Wang, J., Pearce, E., Ma, R., Schlief, M., Lloyd-Evans, B., Ikhtabi, S., & Johnson, S. (2022). Loneliness and the onset of new mental health problems in the general population. Social Psychiatry and Psychiatric Epidemiology, 57(11), 2161–2178. https://doi.org/10.1007/s00127-022-02261-7

[15] Moran, P.D. (2023). Aisles Abroad: Dutch grocer Jumbo embraces a slower checkout option. https://www.grocerydive.com/news/aisles-abroad-dutch-grocer-jumbo-slow-chat-checkouts/6 45702/

[16] National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Behavioral, Cognitive, and Sensory Sciences; Board on Health Sciences Policy; Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press (US).

[17] OMF (2021). Japan Appoints Minister of Loneliness, Can He Solve the Loneliness Problem? https://omf.org/us/japan-appoints-minister-of-loneliness-can-he-solve-the-loneliness-problem/

[18] Rapolienė, G., & Aartsen, M. (2021). Lonely societies: low trust societies? Further explanations for national variations in loneliness among older Europeans. European Journal of Ageing, 19(3), 485–494. https://doi.org/10.1007/s10433-021-00649-z

[19] The New York Times (2023). Dr. Ruth Saved People’s Sex Lives. Now She Wants to Cure Loneliness. https://www.nytimes.com/2023/11/09/nyregion/dr-ruth-loneliness-ambassador.html

[20] World Health Organization (2024). Social Isolation and Loneliness. https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-a geing/social-isolation-and-loneliness

[21] Yang, J., & Moorman, S. M. (2021). Beyond the Individual: Evidence Linking Neighborhood Trust and Social Isolation Among Community-Dwelling Older Adults. International Journal of Aging & Human Development, 92(1), 22–39. https://doi.org/10.1177/0091415019871201

[22] Yanguas, J., Pinazo-Henandis, S., & Tarazona-Santabalbina, F. J. (2018). The complexity of loneliness. Acta bio-medica: Atenei Parmensis, 89(2), 302–314. https://doi.org/10.23750/abm.v89i2.7404

Menopause: A Guide

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Menopause: A Guide

Darshana Shah

March 2024

An Introduction

Women of all ages feel the effects of the menstrual cycle. At a young age, females experience their first periods with cramps, mood swings, and even PMS (Premenstrual Syndrome) that stick with them until they hit menopause. However, even when women feel their menstruation cycle coming to an end, the body can experience vast fluctuations due to changes in hormones during the menstruation cycle. Many women, experiencing periods for years, feel perplexed and anxious due to the changes in their bodies and find it hard to reach out and get the right support.

By definition, menopause is the time after which the menstrual cycle has stopped. Usually, it is diagnosed once 12 months have gone by without a menstrual period.^[1] Generally speaking, most women experience the transition period of menopause in their 40s and menopause in their 50s; however, factors such as stress, lifestyles, and diets can result in menopause occurring at varying times for different women.

Causes

Similar to the initial experience of menstruation, menopause is a natural biological process that signifies the end of a woman’s menstruation cycle. Generally speaking, the cycle for menopause is gradual and slow – periods can appear to be further apart and less frequent during this time in the cycle.

There is also premature menopause which could occur for women who are experiencing menopause before they hit their 40s. Generally speaking, 5% of women experience premature menopause, and although this number may seem low, many women suffer from the side effects of premature menopause.^[2] Some of these side effects include reduced ability to get pregnant as ovulation is slowed, an increased risk of osteoporosis (which is when bones in the body become weak), and even cardiovascular disease.^{[3 ]}As seen by these side effects, premature menopause leaves women susceptible to higher risks of serious health issues as women experiencing premature menopause go longer without experiencing or retaining the benefits of estrogen.

Stages

The 12 months before being diagnosed with menopause are known as perimenopause. While perimenopause may not significantly disrupt the day-to-day life of certain individuals, it is common for this time period to result in physical, emotional, mental, and social changes that can deeply affect women’s lifestyles. Similarly, the period of perimenopause can differ from person to person; while it could last for a year for one individual, it could last several more years for another.

Following perimenopause is menopause, which is the time after a woman has gone without a period for 12 months as previously stated. At this point, the reproductive system comes to a stop and the ovaries will cease to produce eggs. This also means that after menopause, women can no longer bear children naturally. However, with the use of ART, or assisted reproductive technology, the possibility of bearing children still exists. Despite it being a natural biological process, menopause can also occur as a result of surgery or other medical procedures such as chemotherapy.

The last stage is post-menopause which is simply the time after the 12 months of menopause and generally, this time period could alleviate some of the side effects and symptoms which are explained in more detail in the next section. Since every woman’s body is different, the post-menopause time period can differ for each woman; as a result, some women will experience the side effects for a longer period of time, sometimes amounting to a decade after menopause.

Effects

Some side effects of menopause include hot flashes, night sweats, vaginal dryness, urinary urgency, difficulty sleeping, emotional changes, dryness on the skin, breast tenderness, and sometimes even the worsening of PMS.^[4] These are symptoms that are often experienced leading up to the time of menopause and are the most common ones that are experienced. Not only do these carry over into menopause, but they are also good indicators of the start of menopause.

Since menopause also causes a hormonal change in the body, symptoms can differ from person to person. Some uncommon effects include headaches, muscle and joint pain, racing heart, hair loss, and difficulty concentrating. ^[5]

What Can Be Done

The best way to deal with menopause and its effects is to understand what menopause is and how it can affect one’s body. There are always doctors available to help, and often gynecologists will support women through their journey throughout menopause by providing advice and guidance along the way. It is also important to recognize the changes that occur in the body and understand that it is a natural process, and with the proper support system and knowledge, the journey can be made less stressful.

References

[1] Mayo Foundation for Medical Education and Research. (2023, May 25). Menopause. Mayo Clinic.

[2] Early and premature menopause. NHS inform. (2024, January 22).

[3] Mayo Foundation for Medical Education and Research. (2023, May 25). Menopause. Mayo Clinic.

[4] Cleveland Clinic Medical. (n.d.). Menopause: What it is, age, stages, signs & side effects. Cleveland Clinic.

[5] Cleveland Clinic Medical. (n.d.). Menopause: What it is, age, stages, signs & side effects. Cleveland Clinic.

Breast Health Awareness: Understanding Breast Cancer Risk Factors & Screening Guidelines

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Breast Health Awareness: Understanding Breast Cancer Risk Factors & Screening Guidelines

Ivy Le

March 2024

Overview:

Breast cancer continues to be one of the most prevalent health concerns among women worldwide. In the pursuit of women’s wellness, understanding breast health is crucial. From recognizing risk factors to adhering to screening guidelines, knowledge is power in the fight against breast cancer.

What is Breast Cancer?

Breast cancer is a complex disease that is characterized by the uncontrolled growth of abnormal cells in the breast tissue. It typically begins in the milk ducts or lobules of the breast, where cells undergo genetic mutation that cause them to proliferate uncontrollably. As mutated cells multiply and accumulate, they form a tumor within the breast tissue. These tumors can be benign, meaning they are non-cancerous and confined to their site of origin, or malignant, indicating cancerous growth with the potential to invade nearby tissues and metastasis to distant organs. These mutations can occur from a variety of factors in which we will discuss in this article.

Knowing the Risk Factors:

Awareness begins with understanding the factors that can influence breast cancer susceptibility. While some risk factors are out of our control, such as genetics and family history, others are modifiable through lifestyle changes. For instance, age is a significant risk factor with the likelihood of breast cancer increasing as women grow older. Additionally, reproductive factors like early menstruation, late menopause, and nulliparity (never giving birth) can impact risk levels.

Lifestyle choices also play a role. Excessive alcohol consumption, smoking, a sedentary lifestyle, and a diet high in processed foods have been linked to increased breast cancer risk. Conversely, maintaining a healthy weight, regular exercise, and a diet rich in fruits, vegetables, and whole grains can potentially lower the risk of breast cancer.

Genetic mutations, such as those in the BRCA1 and BRCA2 genes, are known to significantly increase the risk of breast cancer. These mutations can be inherited from one’s parents or acquired over time due to exposure to carcinogens or other factors. Hormonal influences also play a crucial role in breast cancer development. Estrogen, in particular, can stimulate the growth of breast cells, making hormone receptor-positive breast cancers more prevalent.

Knowing the Symptoms:

Recognizing the symptoms of breast cancer is crucial for early detection and prompt intervention. While symptoms may vary among individuals, common signs may include:

New lump or mass in the breast or underarm area

Changes in breast size or shape

Nipple discharge

Nipple inversion

Skin changes on the breast, such as redness, dimpling, or puckering

Persistent breast pain or discomfort

Women should familiarize themselves with the normal look and feel of their breasts and promptly report any changes to their healthcare provider. Breast self-exams aren’t a substitute for a regular screening, but can serve as a valuable tool in early detection.

The Importance of Screening:

Early detection remains the cornerstone of breast cancer management, greatly improving treatment outcomes and survival rates. Therefore, adhering to recommended screening guidelines is crucial for every woman.

For women with average risk, screening typically involves mammograms, which are X-ray images of the breast tissue. Guidelines from organizations such as the American Cancer Society recommend starting annual mammograms at age 40, although individual risk factors may prompt earlier or more frequent screen discussions with healthcare providers.

Women at a higher risk, such as those with a family history of breast cancer or genetic mutation like BRCA1 and BRCA2, may require additional screening modalities, such as breast MRI or ultrasound, and may begin screening at an earlier age.

Breast Cancer Treatment:

Breast cancer treatment approaches vary depending on factors such as the stage of the cancer, its specific characteristics, and the individual’s overall health.

Surgery: Lumpectomy (removal of the tumor and a small portion of the surrounding tissue) or mastectomy (removal of the entire breast), which is sometimes followed by reconstructive surgery.
Chemotherapy: Using drugs to kill cancer cells or stop their growth.
Radiation therapy: Using high-energy rays to target and destroy cancer cells.
Hormone therapy: Blocking the effects of estrogen or progesterone on breast cancer cells.
Targeted therapy: Attacking specific vulnerabilities in cancer cells.

Facts About Breast Cancer:

In the United States, approximately 240,000 cases of breast cancer are diagnosed in women and about 2,100 in men annually.
Presently, over four million women in the United States have a past experience of breast cancer, encompassing those undergoing treatment as well as those who have completed their treatment.
Typically, women carrying a BRCA1 mutation face a lifetime risk of breast cancer of around 72%, while those with a BRCA2 mutation have a risk of up to 69%. Breast cancer linked to BRCA1 or BRCA2 mutations tends to manifest more frequently among younger women.
Black women face a higher likelihood of succumbing to breast cancer compared to women from other racial or ethnic backgrounds. This is attributed in part to the fact that approximately one out of every five Black women is diagnosed with triple-negative breast cancer, a proportion higher than that observed in any other racial or ethnic group.

Conclusion

Breast health awareness is a journey that begins with understanding and ends with action. By empowering women with knowledge about breast cancer risk factors and screening guidelines, we can strive toward more effective prevention, early detection, and treatment strategies, ultimately carving a path of a future where women know more about their health and well-being.

References

[1] Breastcancer.org Staf . “Breast Cancer Facts & Statistics.” Accessed 15 March 2024, Breastcancer.org, https://www.breastcancer.org/facts-statistics.

[2] CDC Staf . “Breast Cancer Awareness.” Accessed 15 March 2024, Center for Disease Control and Prevention,

https://www.cdc.gov/cancer/dcpc/resources/features/breastcancerawareness/index.htm