Understanding Pelvic Organ Prolapse: Causes, Symptoms, and Treatment
Steven Shin October 2024
Pelvic organ prolapse (POP) is a condition seen primarily in elder women. It occurs when the muscles and connective tissues that support the pelvic organs become weakened or damaged. This weakening allows the organs to drop from their usual positions and cause discomfort that potentially affecting a woman’s quality of life. While pelvic organ prolapse can be distressing, treatment options exist and this can be managed without surgery [1].
The causes of pelvic organ prolapse are multifactorial, but pregnancy and childbirth remain the most significant risk factors. During childbirth, the pelvic floor undergoes extreme stress. The levator ani muscles and the connective tissue that secures the vagina to the sidewalls of the pelvis are both vital for maintaining pelvic stability. In a healthy individual, the vagina is positioned horizontally on top of the levator ani muscles, offering robust support to the pelvic organs [2]. However, the levator ani muscles can stretch beyond their normal limits that leads to injury. This overstretching causes the vaginal opening to widen and shifts the burden of support from the muscles to the connective tissues.
Aging is the second most common cause of pelvic organ prolapse as muscle strength and tissue elasticity naturally decline over time. The lack of estrogen weakens the muscles and connective tissues of the pelvic floor, further exacerbating the risk. Other risk factors of Pelvic Organ Prolapse include obesity, chronic conditions such as diabetes or constipation, and lifestyle habits such as smoking [2].
Symptoms of Pelvic Organ Prolapse
Many women with pelvic organ prolapse may not notice any symptoms. On the other hand, women may experience a range of symptoms that affect their quality of life. The most common sign of prolapse is a feeling that something is “coming down” or a bulge protruding from the vaginal opening. Some women may feel or see a soft lump while washing themselves, while others might experience discomfort, pressure, or a dragging sensation in the pelvic area. Some may notice difficulty with bowel movements or find it challenging to keep tampons in place.
Treatments of Pelvic Organ Prolapse
Not all cases of pelvic organ prolapse require medical treatment. Mostly, women with mild symptoms can manage their condition with lifestyle changes and conservative treatments. However, certain situations, such as sores on the vaginal wall or bladder problems like ureteral kinking may require medical treatment. Regardless, please see your doctor the moment you notice symptoms.
For women’s non-surgical options, Kegel exercises are often recommended. These exercises target the muscles that support the pelvic organs and can help strengthen them. Working with a pelvic floor therapist improves the effectiveness of these exercises. Pessaries, small silicone devices inserted into the vagina, can provide additional support to the pelvic organs [3]. These devices help relieve symptoms by holding the vaginal walls in place.
Lifestyle modifications like avoiding heavy lifting, quitting smoking, and managing constipation can also reduce symptoms. Obesity and chronic health issues like diabetes and constipation aggravate prolapse, so managing these factors is crucial.
For women with more severe prolapse that significantly affects their quality of life, surgery may be necessary. Surgical procedures aim to repair and reinforce the damaged tissues, restoring the organs to their proper positions. Surgery can be performed either through the abdomen or the vagina [3]. In cases where the prolapse causes more serious complications, such as difficulty emptying the bladder or bowel, surgery may be the best option to restore normal function. However, about 25% of women may require additional surgeries later due to the recurrence of prolapse [3].
Pelvic organ prolapse is a common condition that affects many women. It is often treatable, and many women can manage their symptoms without surgery. Non-surgical treatments, such as pelvic floor exercises and pessaries, can be highly effective. For those with more severe cases, surgery is an option to improve quality of life. If you suspect you have pelvic organ prolapse, it’s important to consult your healthcare provider to explore the best treatment options for your individual needs.
Reference
[1] Iglesia, C. B., & Smithling, K. R. (2017). Pelvic organ prolapse. American family physician, 96(3), 179-185.
[2] Collins, S., & Lewicky-Gaupp, C. (2022). Pelvic organ prolapse. Gastroenterology Clinics, 51(1), 177-193.
[3] American College of Obstetricians and Gynecologists. (2019). Pelvic organ prolapse. Urogynecology, 25(6), 397-408.
Polycystic Ovarian Syndrome: Understanding your Symptoms and Knowing your Treatment Options
Chaimaa Riad October 2024
Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects around 5-10% of women of reproductive age.[4]While its prevalence is high, scientists are unsure of the cause of this disorder. Symptoms can often be overlooked, as PCOS can present in a variety of ways with very general symptoms. It is specifically challenging to diagnose PCOS in young girls because symptoms can often be seen as normal signs of puberty.[2] [4]It is important to recognize any signs and symptoms of hyperandrogenism and express concerns to your primary care provider to get the tests necessary to diagnose PCOS.
Signs and Symptoms to Consider
Family history is important to consider:
Let your doctor know if there is a history of PCOS in the family, or a family history of acne, hirsutism, or obesity.[2]
PCOS is strongly associated with metabolic dysfunction:
Women should be aware of recent weight gain. While girls going through puberty are likely to gain weight, there should be a discussion of the progression of the weight gain. [2]
Signs of insulin resistance are also associated with PCOS. The increase in fat associated with hyperandrogenism is likely to cause your body to not be able to respond properly to the insulin created in your body, leading to an increase in sugar levels, leading to type 2 diabetes.[2]
Primary amenorrhea (failure to get a first period by 15 years old)[1]
Secondary amenorrhea (not having a period for at least three months)[1] ○ Infertility[1]
Skin changes
Hirsutism (excess hair growth on the face or body) [2]
Abnormal acne or oily skin [1] [2]
Acanthosis nigricans (hyperpigmentation usually in the axilla, groin, and neck secondary to diabetes).[2][3]
Cardiovascular concerns
Although unclear, there have been concerns about atherosclerosis forming in young women who have PCOS. This can increase risk of stroke as well as heart attacks. More studies need to be done to properly assess this risk in women with PCOS.[1]
Diagnosis
According to the World Health Organization, diagnosis of PCOS includes at least two out of three of the following:
Symptoms that suggest high androgens (hirsutism, acne, high testosterone levels on lab testing) with no explanation of why there are high androgen levels [5]
Irregular menstrual cycles, as explained above in greater detail [5]
Ultrasound imaging showing polycystic ovaries [5]
Laboratory studies are especially important to ensure that other endocrine disorders are ruled out, including:
After a diagnosis of PCOS is made, there are various methods of management:
Lifestyle modifications – a healthy diet and increased physical activity are ways that can help manage the comorbidities of PCOS including diabetes and obesity. In addition to this, women should follow up with their PCP to assess for any worsening of diabetes or any development of cardiovascular changes such as hypertension.[1]
Medical management: As discussed, diabetic management can vary, and can be managed with medication, as well as hypertension.[1] Additionally, oral contraceptives can help with irregular menstrual cycles.[1] Specific types of medication vary based on the presentation and severity of the specific symptoms.
There is no specific management for PCOS, but rather symptom-based intervention to help prevent serious complications. It is important to discuss with your PCP to know which specific intervention is right for you based on your symptoms. [1][4]
References
[1] Hoeger, K. M., Dokras, A., & Piltonen, T. (2020, November 19). Update on PCOS: Consequences, challenges, and guiding treatment. OUP Academic.
[2] Screening and management of the hyperandrogenic adolescent. ACOG. (2024). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-an d-management-of-the-hyperandrogenic-adolescent
[3] Teede, H. J., Piltonen, T., Costello, M. F., & Misso, M. L. (2018, August). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. American Society for Reproductive Medicine. https://www.fertstert.org/article/S0015-0282(18)30400-X/fulltext
[4] Why polycystic ovarian syndrome is often misdiagnosed. Why Polycystic Ovarian Syndrome Is Often Misdiagnosed: Women’s Healthcare of Princeton: Gynecologists. (n.d.). https://www.princetongyn.com/blog/why-polycystic-ovarian-syndrome-is-often-misdiagnosed [5] World Health Organization. (2023, June). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
Debunking the Myth: No Link Between Cellphone Use and Cancer?
Steven Shin September 2024
The rapid increase in cellphone usage over the past few decades has sparked significant public concern about potential health risks, especially the risk of developing brain cancer. Considering the usage of cell phones, even a slight increase in cancer risk could have significant public health implications. This concern has been particularly serious regarding brain and central nervous system cancers, as phones are often used close to the head. However, recent research offers stunning news: there is no conclusive link between cellphone use and brain cancer (Karipidis, 2024, p.33-39).
The potential danger of cellphone radiation originates from the fact that these devices emit radiofrequency energy, a type of nonionizing radiation. Nonionizing radiation is low-frequency and low-energy, so it is known to damage DNA and increase cancer risk, unlike ionizing radiation such as X-rays and cosmic rays.
The research suggests that energy from cellphone radiation is too weak to cause DNA damage, which is a key mechanism through which cancers can develop. The biological effect of radiofrequency radiation on the human body is a slight heating of the tissue in the area where the phone is held, but this heating is minimal and not sufficient to increase core body temperature or cause harm. Additionally, no increase in the incidence of leukemia or brain cancer was observed in children exposed to radio or TV transmitters or cellphone towers (Karipidis, 2024).
These findings are significant in of the fears that have lingered since 2011 when the International Agency for Research on Cancer (IARC) classified radiofrequency electromagnetic fields as a possible factor that causes cancer. This past result is thought to be a bias that arose from distorted result analysis when individuals with brain cancer compared to those without. Nowadays, the newer generation of cellphone networks like 3G and 4G plays a role in reducing potential risks because they emit significantly lower levels of radiofrequency radiation compared to older networks (Karipidis, 2024, p.45). Moreover, the presence of more cellphone towers shows a decrease in the amount of radiation emitted from individual cell phones.
Over the years, cohort studies and case-control studies have been the primary methods used to conduct the experiment. Case-control studies compare cellphone use between individuals with tumors and those without, while cohort studies follow large groups of people over time to observe tumor development among cellphone users and non-users.
Another important aspect of the research is its consideration of the lack of evidence regarding the health effects of 5G networks. While no major studies have specifically examined the long-term effects of 5G, existing research on radar technology, which operates at similar frequencies, has not shown an increased risk of cancer (Safari Variani, A, 2019, p.7-9). This comparison provides additional reassurance to the public as new technologies continue to emerge and spread rapidly.
These findings emphasize a trend that the introduction of new technologies often initiates public fears about potential health danger. The most recent example of this phenomenon was the widespread but unproven belief during the COVID-19 pandemic that 5G cellphone towers were spreading the virus. This once led to attacks on cell towers in a few regions. Long-term research about new technologies can change the rapidly created fear and bias of crowds.
In conclusion, concerns about the potential link between cellphone use and cancer due to the widespread use of these devices arose, but recent research shows that this is not true. The WHO commissioned research including epidemiological studies has found no conclusive evidence that cellphone use increases the risk of cancer. The radiofrequency radiation emitted by cell phones is nonionizing and too weak to damage DNA. Plus, advances in cellphone technology, such as lower emissions from newer networks and the increased presence of cellphone towers, decrease any potential risks. As new technologies like 5G continue to appear, further research is essential to monitor long-term health effects.
References
[1] Karipidis, K., Baaken, D., Loney, T., Blettner, M., Brzozek, C., Elwood, M., … & Lagorio, S. (2024). The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies–Part I: Most researched outcomes. Environment International, 108983.
[2] Safari Variani, A., Saboori, S., Shahsavari, S., Yari, S., & Zaroushani, V. (2019). Effect of Occupational Exposure to Radar Radiation on Cancer Risk: A Systematic Review and Meta Analysis. Asian Pacific Journal of Cancer Prevention, 20(11), 3211-3219. doi: 10.31557/APJCP.2019.20.11.3211
Balancing Minds and Hormones: Unraveling the Impact of Contraceptives on Young Girls’ Mental Health
Janani Devkumar
August 2024
The growing association between mental health and hormonal contraceptive use is becoming an issue of rising concern for young girls. Due to the wide scope of benefits provided from hormonal birth control, ranging from acne management to pregnancy prevention, the utilization of this medicine has become more prevalent among adolescents. As a consequence, the mental health implications of these medications have come under growing inspection. This article focuses on the relationship between hormonal contraceptives and mental health disorders in young adolescents, further highlighting the significance of well-informed decisions for the betterment of young girl’s healthcare.
The Impact of Hormonal Contraceptives on Mental Health
Hormonal contraceptives, including birth control pills, injections, and implants, are put into effect by changing the body’s natural hormone levels in attempts to avoid accidental pregnancies. These methods, despite having a high efficiency rate, have the potential to affect the brain’s chemistry. This could cause alterations in the adolescents mood as well and negatively impact their mental health. The two main hormones that are influenced by contraceptives are estrogen and progesterone, which are responsible for inflicting changes to the mental health of the individual.
A study published in JAMA Psychiatry led to the conclusion that young girls that utilize hormonal contraceptives were 80% more likely and in greater risk of being diagnosed with depression in comparison to those who did not use these methods. [1] In addition, a separate study brought awareness to the unfavorable consequences that resulted from the usage of these medications by highlighting that young adolescents who used combined oral contraceptives had a 70% increased risk of developing symptoms of anxiety compared to those who did not. [2]
Risk Factors Involved
Various factors can increase the risk of experiencing mental health issues from hormonal contraceptives. This includes pre-existing mental health conditions, such as a previous experience or history with depression or anxiety. In addition, genetic proneness, such as a family history of mental health disorders, can also influence the extent to which a girl’s body reacts in a negative manner to these hormones.
Research that was conducted by the University of Copenhagen found that teenage girls who possessed a history of mental health issues had almost double the risk of experiencing worsening symptoms after starting hormonal contraceptives. [3] To expand, a longitudinal study expressed that those with a family history of depression had a higher likelihood of developing symptoms related to depression following the introduction of hormonal birth control into their system. [4]
Conclusion
The correlation between mental health disorders and hormonal contraceptives for adolescent girls is a complex and highly prevalent issue in today’s society. Despite the benefits that result from taking these medications, the potential negative consequences on mental health for those who take them cannot be overlooked. It is important to understand that great consideration must go into deciding whether or not hormonal contraceptives are the best route for young girls.
References
[1] Skovlund, C. W., Morch, L. S., Kessing, L. V., & Lidegaard, Ø. (2016). Association of hormonal contraception with depression. JAMA Psychiatry, 73(11), 1154-1162.
[2] Zettermark, S., Perez Vicente, R., & Merlo, J. (2018). Hormonal contraceptive use among adolescent girls and subsequent depression: A nationwide population-based cohort study. BMJ Open, 8(11), e024813.
[3] University of Copenhagen. (2017). Impact of hormonal contraception on mental health in young women. Scandinavian Journal of Public Health, 45(5), 483-491.
[4] Bratke, S., & Sundström, A. (2020). Hormonal contraception and the risk of mental health disorders: A systematic review. Journal of Psychiatric Research, 126, 75-85.
The Silent Toll: How Workplace Stress Disrupts Women’s Menstrual Health in High-Pressure Careers
Janani Devkumar
August 2024
The workplaces in today’s modern society stand responsible for stimulating high stresses and intense pressures in their employees. Despite the shared experiences of tension among both men and women, demanding professions inflict unique challenges particularly for females in regard to their menstrual health. Research depicts a strong correlation between workplace stress and menstrual irregularities that are highly prevalent in female employees who are placed in demanding positions in their field of labor. This article delves into the specifics of these consequences while simultaneously highlighting the need for better support systems for women placed in these high-pressure environments.
Stress can be responsible for a variety of hormonal changes that occur within the body. This can be initially stimulated by the release of cortisol, which can be otherwise referred to as the “stress hormone”. As the levels of cortisol rises, it impedes a region of the brain primarily known for its regulation of the menstrual cycle: the hypothalamus. Disruptions to this section can stimulate imbalances in hormones including estrogen and progesterone. This further links to menstrual inconsistencies, such as missed periods, unpredictable cycles, and intensified symptoms.[1]
A study conducted by the American Psychological Association illustrated that women who are involved in work atmospheres with intense pressure are more likely to experience menstrual irregularities. The research further reported an approximation of 40% claiming to have pissed periods and 25% possessing an experience with significantly heavier menstrual bleeding during periods of high stress. [2] In addition, another study put forth the notion that women participating in high-pressure areas of work, such as medicine and law, had a 33% higher chance of experiencing extreme menstrual cramps in comparison to women who were involved in fields that were less demanding. [3]
Nurturing a Healthier Work Environment
In order to alleviate the stress that the workplace imposes on menstruation for women in high stress jobs, employers must take measures to create a healthy atmosphere. This may include promoting flexible work policies, such as remote work positions, which can assist women in managing their stress with greater care. A study published in the Journal of Occupational Health Psychology further explored how flexible work patterns diminished menstrual interferences in 60% of women participants. [4]
Conclusion
Workplace stress is difficult to avoid in modern life and fields of work, however its impact on women’s menstrual health should not be left unnoticed. Through efforts to understand the association between stress and menstruation as well as fostering supportive work environments, employers can help reduce some of the burdens placed on women active in high-stress jobs.
References
[1] Chandraratna, S., & Harlow, S. D. (2022). Stress and menstrual cycle irregularity: A prospective study of the effect of workplace stress. Journal of Women’s Health, 31(3), 300-306.
[2] American Psychological Association. (2023). Stress and menstrual health: How workplace pressure affects women’s cycles. APA Research, 45(2), 112-119.
[3] Cousins, S., & Maguire, K. (2021). The impact of occupational stress on menstrual health among women in high-stress professions: A review. Women’s Health Issues, 31(6), 452-460.
[4] Allen, R., & Parker, J. (2022). The effect of flexible work policies on women’s health outcomes in high-stress jobs. Journal of Occupational Health Psychology, 27(3), 205-213.
Amenorrhea: How The Absence of Menstruation Can Be a Problem
Gabriela Castro May 2024
If you have a uterus, there’s a chance your period has not always come on a regular monthly basis. The chronic absence of a period can be indicative of a medical condition called amenorrhea. There are two types of amenorrhea–primary and secondary.[4] Primary amenorrhea refers to those with uteruses who have not had their first period (also known as “menarche”) by age 15.[3] Secondary amenorrhea is the absence of 3 or more consecutive periods by someone who has begun to menstruate previously.[3]
The central feature of amenorrhea is a lack of menstruation. Other symptoms associated with amenorrhea can vary in part due to its causes, including::
Milky nipple discharge[3]
Hair loss[3]
Headache[3]
Vision changes[3]
Excess facial hair[3]
Pelvic pain[3]
Acne[3]
Primary Amenorrhea Causes
Primary amenorrhea is caused primarily by hormonal imbalances and genetic abnormalities.[5]
Having hypothalamic issues can prevent the onset of menstruation.[5]
Issues with the pituitary gland such as pituitary tumors can inhibit menstruation.[5]
Low body weight, excessive exercise, and eating disorders can cause stress which affects hormone production (particularly in the pituitary gland or hypothalamus leading to amenorrhea).[3]
Genetic abnormalities such as a lack of reproductive organs or a structural abnormality obstructing the vagina can block visible bleeding.[3] Chromosomal issues such as Turner syndrome–which is caused by a missing or partly missing X chromosome–or genetic disorders like androgen insensitivity syndrome–often characterized by high testosterone levels–may affect menstruation.[5]
Secondary Amenorrhea Causes
Secondary amenorrhea has a wider variety of causes.
It can be brought on naturally through pregnancy, breastfeeding, or menopause.[5] This type of amenorrhea can be brought on by hormone imbalance in ways similar to primary amenorrhea.
Hypothalamic amenorrhea–associated with low body weight, body fat, high stress, extreme exercise–can result in secondary amenorrhea.[5] Other hormonal imbalances that result in amenorrhea can be overactive or underactive thyroid, or pituitary tumors.[5][3]
Uterine scarring as a result of various medical interventions (including dilation and curettage (D&C), cesarean section, or treatment for uterine fibroids) may cause amenorrhea.[5][3]
Medications such as contraceptives, antipsychotics, antidepressants, blood pressure medications, chemotherapy radiation, and allergy medications are also known to cause secondary amenorrhea.[5][3]
Prevalence
With the wide array of underlying causes, you might be wondering, how common is amenhorrea? When focusing on women who menstruate, the American College of Obstetricians and Gynecologists estimated that 1 in 25 women who are not pregnant, breastfeeding, or going through menopause experience amenorrhea at some point in their lives.[1] If you struggle with amenorrhea, you should know you are not alone.
Treatments
If you or someone you know is struggling with amenorrhea, it can be a sign of a deeper issue especially if it is not because of natural causes like pregnancy or menopause. That is why it is important to discuss your menstrual cycle with your healthcare provider, including any other symptoms you’ve been experiencing. Depending on the root cause of amenorrhea, treatment can vary from psychological therapy, stress management, eating disorder treatment, changing medications, surgery, chemotherapy, or radiation.[2] Whatever the cause is, you do not have to endure amenorrhea without help or guidance. Taking the first step by sharing your concern with your health care provider and a trusted loved one will ensure you are in good hands and supported in your recovery.
[4] Fragile x-associated primary ovarian insufficiency (Fxpoi) | nichd—Eunice kennedy shriver national institute of child health and human development. (2021, August 19). https://www.nichd.nih.gov/health/topics/fxpoi
Reviving Passion: Exploring Causes and Solutions for Low Libido
Paz Etcheverry, MS, PhD May 2024
Low libido means having a low appetite for sex and, just like vaginismus, it falls under the category of sexual disorders that afflict women. When coupled with elevated stress levels attributed to diminished libido, the condition is known as hypoactive sexual desire disorder.[19]
Low sex drive is the most common sexual issue reported by women.[18] Research reveals that low sexual desire impacts 26 out of every 100 premenopausal women,[10] while the prevalence increases to 52 out of every 100 menopausal women in the US.[19] And while low sex drive can affect women of all ages, studies suggest that younger women find low libido to have a greater lifestyle effect.[1]
Age is one major factor that can contribute to low libido. Starting at the age of 45, there is a decrease in sex hormones, primarily estrogen and testosterone. Low estrogen levels lead to vaginal dryness, which can make penetrative sex particularly painful, a condition known as dyspareunia. Furthermore, low estrogen levels lead to reduced sensitivity in the genital area, which can impede a woman’s ability to actively respond to sexual expression and cues.[1]
Testosterone is a major driver of sex as it enhances sexual desire and behavior. By the time women reach menopause, between ages 40 and 60, their testosterone levels are almost a quarter of what they used to be during their 20s.[1] Weight gain and depression can also decrease libido.[17] Relationship difficulties can have a considerable effect on sexual desire, along with emotional stress, the health of the partner, and family conflicts. Moreover, surgical procedures (like oophorectomies, which involve removing one of the two ovaries responsible for estrogen and testosterone production), health conditions, and certain medications such as SSRIs (selective serotonin reuptake inhibitors), can contribute to a diminished libido. These factors may result in the absence of sexual fantasies and a reduced desire for sexual activity.[1][10]
Treatment options for this condition include hormonal treatments and pharmaceutical drugs.
Estrogen
Possible options are oral and local estrogen, such as patches, creams, and rings inserted in the vagina. A caveat with oral estrogen: they lower levels of testosterone, which we know is a major driver of sexual desire. Hence, local estrogen options, which have minimal effects on testosterone levels, might be more suitable. Vaginal moisturizers, as well as water, oil, or silicone-based lubricants, can be used when vaginal dryness is suspected.[10]
Testosterone
Oral testosterone is not an option for women because of the effects it has on blood lipid levels. Instead, patches are recommended. Frequent adverse effects associated with testosterone patches include a rise in body hair or hirsutism (observed in 7% compared to 5% in controls), acne (reported in 9% compared to 7% in controls), and irritation at the patch site affecting up to 30% of participants. These effects resolve, however, following discontinuation of treatment.[10] Additionally, there are testosterone creams and gels that, when applied to the upper thighs, abdomen, and forearms, can enhance sexual desire without significant side effects,[6][7][16] although the risk of acne and hirsutism remains possible.
Tibolone
For menopausal women, tibolone may be a beneficial treatment option.[5][8] As a synthetic steroid, tibolone is marketed as hormone replacement therapy. However, there are concerns regarding the potential risk of stroke in older women using tibolone, despite its positive effects on breast cancer, fracture risk, and possibly colon cancer.[4]
Dehydroepiandrosterone or DHEA
Touted as the “elixir of youth”, DHEA is converted in various body tissues into estrogen and testosterone.[3] DHEA is available over-the-counter, but its safety remains unclear.[11]It is also unclear to what extent DHEA is beneficial, particularly for libido and general well-being..[12][20]
Flibanserin
Flibanserin is a drug that selectively influences neurotransmitter pathways that are associated with sexual desire.[10]In studies, a daily dose of 100 mg improved sexual desire in women.[9][15] However, the drug has some unwanted side effects such as nausea, dizziness, fatigue, and insomnia.[2]
Bupropion
Bupropion is a drug that enhances sexual desire.[13] Psychiatrists commonly recommend bupropion for the treatment of SSRI-induced low libido due to studies demonstrating its positive impact on desire, arousal, lubrication, orgasm, and satisfaction in women with SSRI-induced sexual dysfunction.[10][14]
There are multiple causes of low libido that may be physical, emotional, medical, or due to relationship conflicts. Treatment options are available to reignite sexual desire. Work with a trusted healthcare provider to explore the various options available and get back to feeling like you.
References
[1] AlAwlaqi, A., Amor, H., & Hammadeh, M. E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of the Turkish German Gynecological Association, 18(4), 210–218. https://doi.org/10.4274/jtgga.2017.0071
[2] Baid, R., & Agarwal, R. (2018). Flibanserin: A controversial drug for female hypoactive sexual desire disorder. Industrial Psychiatry Journal, 27(1), 154–157. https://doi.org/10.4103/ipj.ipj_20_16
[3] Buffington C. K. (1998). DHEA: elixir of youth or mirror of age?. Journal of the American Geriatrics Society, 46(3), 391–392. https://doi.org/10.1111/j.1532-5415.1998.tb01062.x
[4] Cummings, S. R., Ettinger, B., Delmas, P. D., Kenemans, P., Stathopoulos, V., Verweij, P., Mol-Arts, M., Kloosterboer, L., Mosca, L., Christiansen, C., Bilezikian, J., Kerzberg, E. M., Johnson, S., Zanchetta, J., Grobbee, D. E., Seifert, W., Eastell, R., & LIFT Trial Investigators (2008). The effects of tibolone in older postmenopausal women. The New England Journal of Medicine, 359(7), 697–708. https://doi.org/10.1056/NEJMoa0800743
[5] Davis S. R. (2002). The effects of tibolone on mood and libido. Menopause (New York, N.Y.), 9(3), 162–170. https://doi.org/10.1097/00042192-200205000-00004
[6] El-Hage, G., Eden, J. A., & Manga, R. Z. (2007). A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric: The Journal of the International Menopause Society, 10(4), 335–343. https://doi.org/10.1080
[7] Goldstat, R., Briganti, E., Tran, J., Wolfe, R., & Davis, S. R. (2003). Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause (New York, N.Y.), 10(5), 390–398. https://doi.org/10.1097/01.GME.0000060256.03945.20
[8] Kamenov, Z. A., Todorova, M. K., & Christov, V. G. (2007). Effect of tibolone on sexual function in late postmenopausal women. Folia Medica, 49(1-2), 41–48.
[9] Katz, M., DeRogatis, L. R., Ackerman, R., Hedges, P., Lesko, L., Garcia, M., Jr, Sand, M., & BEGONIA trial investigators (2013). Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. The Journal of Sexual Medicine, 10(7), 1807–1815. https://doi.org/10.1111/jsm.12189
[10] Maclaran, K., & Panay, N. (2011). Managing low sexual desire in women. Women’s Health (London, England), 7(5), 571–583. https://doi.org/10.2217/whe.11.54
[11] Omura Y. (2005). Beneficial effects and side effects of DHEA: true anti-aging and age-promoting effects, as well as anti-cancer and cancer-promoting effects of DHEA evaluated from the effects on the normal and cancer cell telomeres and other parameters. Acupuncture & Electro-therapeutics Research, 30(3-4), 219–261. https://doi.org/10.3727
[12] Panjari, M., & Davis, S. R. (2007). DHEA therapy for women: effect on sexual function and wellbeing. Human Reproduction Update, 13(3), 239–248. https://doi.org/10.1093/humupd/dml055
[13] Razali, N. A., Sidi, H., Choy, C. L., Roos, N. A. C., Baharudin, A., & Das, S. (2022). The Role of Bupropion in the Treatment of Women with Sexual Desire Disorder: A Systematic Review and Meta-Analysis. Current Neuropharmacology, 20(10), 1941–1955. https://doi.org/10.2174/1570159X20666220222145735
[14] Segraves, R. T., Clayton, A., Croft, H., Wolf, A., & Warnock, J. (2004). Bupropion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women. Journal of Clinical Psychopharmacology, 24(3), 339–342. https://doi.org/10.1097/01.jcp.0000125686.20338.c1
[15] Simon, J. A., Thorp, J., & Millheiser, L. (2019). Flibanserin for Premenopausal Hypoactive Sexual Desire Disorder: Pooled Analysis of Clinical Trials. Journal of Women’s Health (2002), 28(6), 769–777. https://doi.org/10.1089/jwh.2018.7516
[16] Singh, A. B., Lee, M. L., Sinha-Hikim, I., Kushnir, M., Meikle, W., Rockwood, A., Afework, S., & Bhasin, S. (2006). Pharmacokinetics of a testosterone gel in healthy postmenopausal women. The Journal of Clinical Endocrinology and Metabolism, 91(1), 136–144. https://doi.org/10.1210/jc.2005-1640
[17] Stanikova, D., Zsido, R. G., Luck, T., Pabst, A., Enzenbach, C., Bae, Y. J., Thiery, J., Ceglarek, U., Engel, C., Wirkner, K., Stanik, J., Kratzsch, J., Villringer, A., Riedel-Heller, S. G., & Sacher, J. (2019). Testosterone imbalance may link depression and increased body weight in premenopausal women. Translational Psychiatry, 9(1), 160. https://doi.org/10.1038/s41398-019-0487-5
[18] Sutherland, S. E., Rehman, U. S., & Goodnight, J. A. (2020). A Typology of Women with Low Sexual Desire. Archives of Sexual Behavior, 49(8), 2893–2905. https://doi.org/10.1007/s10508-020-01805-9
[19] West, S. L., D’Aloisio, A. A., Agans, R. P., Kalsbeek, W. D., Borisov, N. N., & Thorp, J. M. (2008). Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Archives of Internal Medicine, 168(13), 1441–1449. https://doi.org/10.1001/archinte.168.13.1441 [20] Wierman, M. E., & Kiseljak-Vassiliades, K. (2022). Should Dehydroepiandrosterone Be Administered to Women?. The Journal of Clinical Endocrinology and Metabolism, 107(6), 1679–1685. https://doi.org/10.1210/clinem/dgac130
The Gender Gap in Alzheimer’s: Why Women Are at Higher Risk
Jessica Luu May 2024
Picture yourself in a room surrounded by people. If each person were to raise their hand to indicate they have Alzheimer’s, you might notice that more women would raise their hands than men. This isn’t a coincidence. Surprisingly, almost two-thirds of Americans living with Alzheimer’s are women.[1] But why is this the case? To understand this gender gap, we need to look at various factors that make women more susceptible to this neurodegenerative disease.
One of the most prominent theories explaining the higher incidence of Alzheimer’s in women involves hormonal changes, particularly those associated with menopause. Estrogen, a hormone that declines sharply during menopause, is believed to play a protective role in brain health. Estrogen receptors are found throughout the brain, and this hormone is known to have neuroprotective properties, including reducing inflammation, promoting synaptic growth, and enhancing cerebral blood flow.[2] This dramatic loss of estrogen during menopause could therefore, make women more vulnerable to the onset and progression of Alzheimer’s disease.
Genetics: The Inherited Risk
Genetics also plays a critical role in the risk of developing Alzheimer’s. The presence of the APOE-e4 allele, a variant of apolipoprotein E gene, is a well-known risk factor for Alzheimer’s disease.[5]Interestingly, research shows that women who carry the APOE-e4 allele are at a higher risk compared to men with the same genetic variant. The reasons behind this heightened vulnerability are not entirely understood, but they may involve differences in how the gene interacts with female-specific factors, such as hormonal changes and other epigenetic mechanisms.[5]
Social and Lifestyle Factors
Women have historically been primary caregivers, which can lead to chronic stress—a known risk factor for Alzheimer’s. Chronic stress elevates cortisol levels, and prolonged exposure to cortisol can cause damage to the hippocampus (the brain region responsible for memory consolidation)[3]. Additionally, women are more likely to experience depression and anxiety,[4] both of which are linked to an increased risk of Alzheimer’s. When you combine these mental health issues with the stress of caregiving and hormonal changes from menopause, it becomes clear why women are more disproportionately affected by the disease than men.
Building Resilience
However, there is hope. By understanding these factors, women can take proactive steps to reduce their risk:
Physical Activity: Engaging in regular exercises and strength training can increase blood flow to the brain and promote the health of brain cells, which may reduce the risk of Alzheimer’s.[1]
Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients that support brain health and may prevent progression of Alzheimer’s.[6]
Mental Stimulation: Keeping your brain active with activities like reading, puzzles, learning new skills, and socializing may build up mental stamina, which in the long run, can delay the onset of Alzheimer’s symptoms. [1]
Quality Sleep: Try to get 7-9 hours of sleep per night, as quality sleep is crucial for memory consolidation and brain health.[1]
Ultimately, by incorporating these changes into one’s daily routine, women can enhance their overall well-being all while mitigating their risk of Alzheimer’s.
As we continue to research more about Alzheimer’s and its effect on women, advocating for greater awareness and support is essential. By doing so, we can ensure that women everywhere can live their life to fullest, today and for generations to come. Together, we can work towards a healthier and brighter future where Alzheimer’s is better understood, prevented, and ultimately cured.
References:
[1] Alzheimer’s Association. (2024). “Alzheimer’s disease facts and figures.” Accessed 22 May 2024, Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures
[2] Alzheimer’s Society. (n.d.). “Hormones and Dementia Risk.” Accessed 22 May 2024, Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia
[3] Browning, M.E., Hocking, C., Hunter, M., Khan, Z., Middleton, C., (2022). “Increased Cortisol and Altered Dehydroepiandrosterone Sulfate Levels in Alzheimer’s Disease. Alzheimer’s Research and Therapy. Accessed 22 May 2024. https://alzres.biomedcentral.com/articles/10.1186/s13195-022-01139-9
[4] Fisher Center for Alzheimer’s Research. (2020). “Depression Increases the Risk for Alzheimer’s.” ALZinfo.org. Accessed 22 May 2024.
[6] Robbins, R. (2020) “What to Eat to Reduce Your Risk of Alzheimer’s Disease.” Harvard Health Blog. https://www.health.harvard.edu/blog/what-to-eat-to-reduce-your-risk-of-alzheimers-disease-20200508197 74
When a Painful Cramp isn’t Just a Painful Cramp: a Guide to Endometriosis
Tanvi Mehta June 2024
Endometriosis is a disease in which tissue similar to that in the lining of the uterus grows elsewhere within the body.[5] When this tissue is in the uterine lining, it regularly breaks down and leaves the body through the menstrual cycle. [4] However, when this tissue is produced outside the uterus it does not have means of exiting the body, causing inflammation and scarring within the pelvic region.[5]
Up to 30% of endometriosis patients do not present with any symptoms at all.[6] However, those that do, often present with excessively painful periods, pain with bowel movements and urination, pain during or after sex, excessive bleeding, infertility, irregular periods, fatigue, and spotting between periods.[3]
Patient Population
Around 10% of women have endometriosis and patients that get diagnosed are usually between the ages of 25 and 40, but endometriosis can start to present in teen years as well. Some risk factors include having a family history of endometriosis, starting periods at a young age (11 or younger), having shorter amounts of time between periods, and defects within your uterus or fallopian tubes.[1]
What does getting diagnosed look like?
Diagnosis begins with your doctor taking a thorough patient medical history which can often give insight. Questions like asking the patient if their periods have always been this painful or if they have any family history of endometriosis can often help doctors discern whether the patient is experiencing endometriosis or potentially another condition.[6]
If the doctor suspects endometriosis, typically they will start with a pelvic exam in which they feel around in the pelvic area with gloved hands for any unusual changes like cysts or irregular growths. Usually, areas of endometriosis cannot be felt in a pelvic exam unless a cyst has formed in the area. If the doctor suspects something, they may move onto ultrasounds which can help to show a better picture of the reproductive organs and any cysts on them. However, an ultrasound is unable to fully confirm the diagnosis and other options like Magnetic Resonance Imaging (MRI) might be needed to get a fuller picture. At this point, a clinical diagnosis based on imaging and symptoms can be made.
Treatment Options
Treatment can vary a lot depending on different factors like progression and severity of the disease, plans for future pregnancies, and age. Medications are often used to symptomatically treat patients’ pain as well as increase fertility.
While these medications may work short-term, the long-term solution to relieve the chronic discomfort from endometriosis is surgery. The problem with surgery is that even with it, symptoms may come back in a few years depending on the disease severity.[1] Laparoscopy, a surgical procedure to check inside the abdomen for signs of endometriosis, is used to get information about the progression of endometriosis growths and also remove them. [4] In severe cases, a hysterectomy may be the best option, considering the progression of the disease and the amount of scar tissue. A hysterectomy is a surgical procedure in which the uterus is entirely removed from the patient’s abdomen.[1]
Causes
Scientists still do not exactly know what the cause of endometriosis is, but it is likely caused by multiple factors like genetics and altered immune system function. The most common theory explaining its origin is the retrograde menstruation theory. This theory suggests that some menstrual blood and uterine lining tissue, which normally exits through the vagina, flows back into the fallopian tubes and pelvis. Thus, endometrial cells attach and grow on tissues in the pelvis.[6]
Often Being Misdiagnosed and Overlooked
The problem with endometriosis diagnosis is that each person’s menstrual cycle experience is unique and subjective. Sometimes, what a patient might believe to be cramp pain at their regular tolerance level could actually be pain from endometriosis. Oppositely, what patients might tell their doctors is unusual extreme pain, might be dismissed as just period cramps. Endometriosis patients often do feel ignored and isolated as their broad symptoms are difficult to diagnose with such little attention being paid to endometriosis in the greater medical domain.[2]
Outlook
Endometriosis is a condition that can affect a person’s daily life, causing long-term pain, disruptions in menstrual cycles, and even infertility. However, patients with endometriosis can very much still have full and meaningful lives with proper diagnosis and treatment![1]
[2] Hudson, N. (2022). The missed disease? endometriosis as an example of ‘undone science.’ Reproductive Biomedicine & Society Online, 14, 20–27. https://doi.org/10.1016/j.rbms.2021.07.003
[4] Mayo Foundation for Medical Education and Research. (2023, October 12). Endometriosis. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
[5] World Health Organization. (n.d.). Endometriosis. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Overview,period%20and%20last%20until%20menopause. [6] Yale Medicine. (2024, March 11). Endometriosis. Yale Medicine. https://www.yalemedicine.org/conditions/endometriosis
Major depression is a widespread chronic illness that significantly contributes to the global burden of disease. In 2010, depressive disorders were the second leading cause of years lived with disability in Canada, the United States, and across the globe. When considering deaths from suicide and stroke related to depression, it ranks third in the global burden of disease. The overall burden of major depression is increasing, and it is expected to be the leading cause of disease burden by 2030, already holding this position for women worldwide. Between 1990 and 2010, Canada saw a 75% increase in disability-adjusted life years due to major depression, second only to Alzheimer’s disease, while the increase in the U.S. was 43%. The female-to-male ratio of global disability from major depression has remained at 1.7:1. While socioeconomic factors such as abuse, education, and income may influence the higher rate of depression in women, this article focuses on biological contributors to this disparity.
The prevalence of major depression is higher in women than in men. In 2010, the global annual prevalence was 5.5% for women and 3.2% for men, a 1.7-fold difference. In Canada, the prevalence in 2002 was 5.0% for women and 2.9% for men, increasing to 5.8% and 3.6% respectively by 2012. These similar ratios across developed countries suggest that the differential risk is mainly due to biological sex differences rather than social or economic factors. The rate of depression does not appear higher in countries where women have significantly lower socioeconomic status than men. Depression is more than twice as prevalent in young women (ages 14–25) than in men, but this ratio decreases with age. Before puberty, boys and girls have similar depression rates, which decline after age 65, becoming similar between genders. This higher prevalence in women is also reflected in the prescription rates of antidepressants, with women in Canada being prescribed these medications more than twice as often as men. The delay in antidepressant treatment for young adults may contribute to higher depression rates in adolescence and young adulthood.
Depression triggers differ between genders, with women more often experiencing internalizing symptoms and men externalizing symptoms. Studies of dizygotic twins suggest women are more sensitive to interpersonal relationships while men are more sensitive to external career and goal-oriented factors. Women also face specific forms of depression-related illnesses linked to hormonal changes, such as premenstrual dysphoric disorder, postpartum depression, and postmenopausal depression and anxiety. This suggests that hormonal fluctuations, particularly estrogen, may trigger depression in women. However, most preclinical studies focus on males to avoid behavioural variability related to the menstrual cycle. Additionally research on primates has shown that social stress can lead to depression-like symptoms and changes in the serotonin system and hippocampal volume, more pronounced in postmenopausal than ovarian-intact monkeys. Furthermore, hormone replacement therapy during perimenopause has shown promise in preventing postmenopausal depression. Studies indicate that oral contraceptive use may reduce depression and anxiety, suggesting that moderating estrogen cycling could be protective.
Despite the lack of systemic estrogen, men have lower depression rates, possibly due to the conversion of testosterone to estrogen in the male brain, providing consistent protection. Men also have androgen receptors that may offer additional protection. These hormonal and developmental differences in brain circuitry contribute to the lower prevalence of depression in men.
The fundamental genetic differences between men and women, such as the presence of X and Y chromosomes, contribute to the differing depression rates. Societal factors likely have a biological basis, yet even with improving social equality, the female-to-male depression ratio remains unchanged. Biological factors, particularly fluctuations in ovarian hormones and decreases in estrogen, appear to significantly contribute to the higher prevalence of depression in women. Developing treatments that target these biological factors could help mitigate this disparity.
References
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J., & Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/s0140-6736(13)61611-6
Ford, D. E., & Erlinger, T. P. (2004). Depression and C-Reactive protein in US adults. Archives of Internal Medicine, 164(9), 1010. https://doi.org/10.1001/archinte.164.9.1010
