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

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.

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

Long-Lasting Effects of Social Media: Understanding How Online Misogyny is Affecting Our Youth

The Dynamics of In Vitro Fertilization and Embracing Autonomy 

What is in vitro fertilization (IVF)? 

Over the past five decades, IVF has emerged as a transformative treatment option for women,  representing a substantial technological advancement in assisting families grappling with  infertility and yearning for children. This intricate process entails a multi-step journey,  requiring dedication and meticulous planning.  

IVF involves several steps, with specific timing playing a crucial role throughout the process.  Reproductive specialists explain that each IVF cycle begins with a patient self-injecting  hormones daily for about 10 to 12 days to stimulate egg production within the ovaries. Regular  monitoring follows until the eggs reach maturity, after which a different hormone triggers their  retrieval under anesthesia – the second step.^[1] 

Subsequently, retrieved eggs are placed in a dish with sperm for fertilization, marking the third  step in the process. The fourth step is the creation of a fertilized egg which is then cultured in a  lab for approximately three to seven days until it reaches the blastocyst stage. This stage  signifies a well-developed embryo containing cells for both the placenta and fetus.^[1] 

The last step in the IVF process involves either transferring the embryo into the woman’s uterus  or freezing it for future use. Often, a combination occurs with one embryo transferred while  any surplus embryos are frozen. The entire IVF cycle, from hormone administration to embryo  implantation, typically spans about 2.5 weeks. However, frozen embryos may be transferred  into the uterus in a separate cycle.^[1] 

Demand for IVF has surged globally, with IVF conceptions accounting for approximately 2%  of all babies born in the United States. This percentage is projected to rise to 10% in the future  as scientific advancements and reliance on IVF persist.^[2] 

Reproductive rights continue to divide the nation 

As of March 2024, IVF remains at the forefront of discussions, marking it as one of the most  talked about topics of the year. Following the reversal of Roe v. Wade, the discussion surrounding IVF also opens another dimension, inviting further scrutiny to women’s  reproductive rights. This ongoing dialogue promises to reignite discussions and inquiries into  the broader landscape of reproductive health and autonomy.

In a recent unprecedented ruling, the Alabama Supreme Court categorized embryos as children,  sparking legal ambiguity regarding fertility treatments. This caused some IVF providers to  suspend services for fear of wrongful death lawsuits when handling their routine disposal of  nonviable and surplus embryos. Along with the potential liability for inadvertent destruction, it  has ignited new debates within the realm of reproductive medicine in the United States.^{[3, 4]} 

This decision prompted public outrage and resulted in lawmakers taking political action by  swiftly passing legislation to offer legal immunity to IVF providers. Following the enactment  of the law, two of the three major clinics in Alabama resumed IVF services. However, legal  experts say the future of those protections are on shaky ground.^[4] 

Medical professionals and advocacy organizations in the reproductive field have expressed  apprehension over the ruling’s potential adverse effects on fertility treatments not only within  Alabama but also across the nation as the discussions continue to evolve on the future of IVF.^[3] 

The future of IVF hangs in the balance 

The Alabama Supreme Court ruling increased apprehension among IVF providers in Alabama  and triggered political turbulence on a national scale, prompting Republicans to distance  themselves from the decision amidst a pivotal election year where reproductive rights are one of  the top issues. 

As the debate rages on surrounding women’s autonomy and the complexity of reproductive  decisions, a critical question remains: Will women emerge victorious in the struggle for control  over their bodies, including the disposition of their eggs and embryos? It is essential that women  are entrusted with this choice as it directly concerns their bodies. Women should be free from the  constraints of legislation, honoring individuals’ rights to make deeply personal decisions  regarding their lives and futures. Since the inception of IVF in 1978, the fundamental goal of  infertility treatment remains the same – helping to build happy, healthy, and flourishing  families.^{[2, 5]} 

References 

[1] Godoy, M. (2024, February 23). The science of IVF: What to know about Alabama’s  “extrauterine children” ruling. NPR. https://www.npr.org/sections/health shots/2024/02/23/1233023637/ivf-alabama-frozen-embryo-personhood-abortion-supreme court.  

[2] Kushnir, V. A., Smith, G. D., & Adashi, E. Y. (2022). The Future of IVF: The New Normal  in Human Reproduction. Reproductive Sciences, 29(3). https://doi.org/10.1007/s43032-021- 00829-3.  

[3] Epstein, K. (2024, February 22). Major Alabama hospital pauses IVF after court rules  frozen embryos are children. www.bbc.com. https://www.bbc.com/news/world-us-canada 68366337. 

[4] Baker, L. (2024, March 6). Alabama lawmakers pass IVF immunity legislation. NPR.  https://www.npr.org/2024/03/06/1235907160/alabama-lawmakers-pass-ivf-immunity legislation.  

[5] Eskew, A. M., & Jungheim, E. S. (2017). A History of Developments to Improve in vitro  Fertilization. Missouri Medicine, 114(3), 156–159. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140213/.

Learning to Exercise With, Not Against, Your Cycle 

Autism in Women: Why it Can Easily Fly Under the Radar 

Rachel Moseley, a Psychology Lecturer at Bournemouth University, recounts how she had endured bullying, social isolation, and depression throughout her adolescence.^[2] Her strange incapability to fit in with everyone else was a shadow that loomed over her head for years.^[2] However, when she received an autism diagnosis during adulthood, it felt like a “light in the darkness.”^[2] She stopped blaming herself for her differences and found her footing in the world. 

Still, this revelation isn’t the norm for many autistic women; in truth, autistic women constantly struggle to be understood by friends, family, and even medical professionals.^[2] 

Society’s View of Autistic Men vs Autistic Women^[1][4] 

The medical world has largely treated autism as a traditionally “male” condition, with studies showing that men are four times more likely than women to receive a diagnosis successfully.^[1][4] The traits and behavior problems autistic men display are a contributing factor, since they tend to be obvious and visible, such as aggression or hyperactivity.^[4] On the other hand, women tend to internalize their symptoms, with these categorized as the following: sensory sensitivity, intense interests, social difficulties, and often coexisting conditions (ADHD, eating disorders, depression, etc.).^[2][3][4] 

It doesn’t help that the comprehension of autism within the medical community derives mostly from research conducted on autistic men^[3] This leads to medical professionals having a minimal understanding of autistic traits unique to women. They’re more likely to brush off women seeking an autism diagnosis, discouraging women from ever seeking professional help again. 

The Truth Behind the Mask 

As autistic girls grow up, most become adept at hiding their autistic traits. Incidentally, there is a word that autistic women use to describe this behavior: masking.^[1][2] They may mimic the behavior of people nearby, force themselves to make eye contact with others, or prepare jokes and phrases in advance for a social setting.^[4] 

In an autistic woman’s world, every social interaction is a challenge—not a time for leisure. If

they slip up, they risk becoming prime targets for harassment and bullying.^[2] Therefore, their “social disguise” becomes the only way they can feel they can navigate their lives. Still, this mask isn’t without its drawbacks. Suppression of their symptoms undoubtedly contributes to the low diagnosis rates.^[4] 

The Grim Consequences of Going Unnoticed 

Studies show that autistic women have higher rates of poor mental health compared to autistic men.^[4] When their narratives are weaved by neglect and powerlessness, it’s no surprise that this is the reality. It also seems that the time of diagnosis and mental health are inextricably connected.^[4] An earlier diagnosis naturally leads to fewer mental health risks, while a later or even no diagnosis fuels the deadly flames of mental illness. 

Sometimes, the outcome is a grim one—indeed, there are high rates of suicide among undiagnosed autistic women. 

A Rocky Road to Support 

Many autistic women who struggle to obtain a professional diagnosis often peruse online forums and social media for a like-minded community of autistics. While this is certainly beneficial, it should not be the only way they feel they can comfortably find help. A professional diagnosis can provide easier access to a multitude of resources.^[3] For instance, it can open up the pathway to receiving cognitive behavioral therapy (CBT), social skills training, or medications for coinciding mental illnesses.^[1][3] Also, it can provide a welcomed gift of validation and support that autistic women have long craved 

The truth is this: when we focus on increasing awareness, we give autistic women the courage to seek out a diagnosis, bolstering their chances of attaining acceptance and freedom from shame. 

References 

[1] Autism in Women: Why We Get Diagnosed Late. A Center for Mental Wellness. https://www.acfmw.com/autism-in-women-why-we-get-diagnosed-late 

[2] Moseley, Rachel. (2023). Like many women, I didn’t know I was autistic until adulthood – how late diagnosis can hurt mental health and self image. The Conversation. https://theconversation.com/like-many-women-i-didnt-know-i-was-autistic-until-adulthood-how late-diagnosis-can-hurt-mental-health-and-self-image-212561 

[3] Osborn, Corrine. (2023). Understanding Autism in Women. HealthLine. https://www.healthline.com/health/autism-in-women#takeaway[4] UCLA Health. (2023). Understanding undiagnosed autism in females. Ucla Health. https://www.uclahealth.org/news/understanding-undiagnosed-autism-adult-females

Scientists have proven that humans have been reading and writing for about 5,000 years.^[4] This can be traced back to 3,000 BCE in Ancient Mesopotamia.^[4] Literacy rates have drastically risen in the last 200 years.^[4] Reading has not only been used for acquiring knowledge and information from academic fields, but has long been a staple activity done for pleasure. I am unsure if it was always consciously well-known, but reading has now been proven to impact mental health. 

I fell in love with books at the tender age of 4. Once I learned how to read on my own, I became consumed by a plethora of stories written by children’s authors. My love for reading evolved as time went on. As a teen, reading became an escape from the effects of teenage angst. In a 2021 study by Civic Science, it was discovered that 44% of adults read for fun every single day. Therefore reading is a healthy escape.^[3] 

When you go to the doctor, they sometimes ask you if you have been experiencing any stress or anxiety lately. Stress levels are at an all-time high due to the state of the world. Relational and systemic problems plague our daily lives. If your doctor advised you to read more as a form of routine stress management, would you do it? We are often tense, we may feel our muscles aching and our chests tightening when feeling stressed. “Reading can lower your heart rate and ease tension in your muscles.”^[2] 

I mentioned that reading was an escape from my teenage angst and it is still one of my favorite escapes. Reading is deemed a healthy escape for a multitude of reasons. It helps us to become more creative, more understanding, feel less alone, etc. Most people can create visuals as they read. This allows them to become further entrenched in what they are reading. Literary fiction, in particular, has been found to improve empathy. This is due to the fact that “literary fiction focuses more on the psychology of characters and their relationships.”^[1] I am an avid reader of literary fiction and I become enthralled by the inner worlds of a character or all characters presented in a story through introspective dialogues. Literary fiction is a genre that emphasizes social behaviors and often teaches readers about human differences. This, in turn, may help us to develop a better understanding or empathy for those who are different from us. At the same time, we must keep in mind that different book genres can help us become more resilient, and empathetic as well as help us with social skills, mindfulness, and so on.

I have recently discovered “Bibliotherapy.” According to Psychology Today, it is a mental health intervention that is basically reading therapy. “It mainly refers to structured book reading programs run by libraries, clinics, or schools with the purpose of promoting recovery in people with mental health difficulties. The term bibliotherapy is also used to refer to self-initiated book reading pursued by an individual with mental illness. This can be supported by a clinician, family member or peer supporter, or pursued alone.” ^[5] 

“Several studies have examined whether bibliotherapy can facilitate recovery from mental illness.”^[5] According to multiple studies, women read more than men do. However, reading can benefit everyone’s mental health, and I would like to encourage people to try finding books or genres that they enjoy reading. If you do not like to read physical books or e-books, you can try listening to audiobooks. While reading will not fully eradicate the mental health crisis in the United States, it can improve your mental health. 

Reading should be accessible to everyone. There are often literacy programs at public libraries that will assist in learning how to read. I would also like to encourage others to obtain a library card. “I am aware that this is not always possible due to not having a permanent home address, among other reasons, among other reasons, but it is worth trying.” A library card can give you access to free books and programs in person and through apps like the Libby app. Additionally, places to purchase inexpensive books include eBay and local used bookstores. Since reading can be a healthy coping strategy, it is important to be aware of the benefits that reading can offer to individuals and the benefits to mental health. Reading may have a surprising impact on your life! 

References

[1] Chiaet, J. (2013, October 4). Novel Finding: Reading Literary Fiction Improves Empathy. Scientific American. https://www.scientificamerican.com/article/novel-finding-reading-literary-fiction-improves-empa thy/ 

[2] National Alliance on Mental Illness. (2020). Why Reading is Good for Mental health. NAMI California. https://namica.org/blog/why-reading-is-good-for-mental-health/ 

[3] Rittenberg, J. (2021, June 10). 44% of U.S. Adults Who Like to Read, Do So for Fun Every Day. CivicScience. https://civicscience.com/44-of-u-s-adults-who-like-to-read-do-so-for-fun/#:~:text=In%20a%20ne w%20survey%2C%20CivicScience,for%20fun%20every%20single%20day.

[4] University of Texas Permian Basin. (2024). The Evolution of Literacy Education. University of Texas Permian Basin. 

[5] Whitley, R. (2019, May 24). Can Reading Books Improve Your Mental Health?. Psychology Today. https://www.psychologytoday.com/us/blog/talking-about-men/201905/can-reading-books-improv e-your-mental-health

Despite the amount of biology, anatomy, and even sex education classes taught in schools, the vast majority of people still do not grasp the basic foundational knowledge of menstruation or female health and sexuality in general. Unfortunately, this can be for so many reasons such as the unwillingness of society or the government to invest in women’s health education, the idea of menstruation or female sexuality being shameful, a taboo, or just simply “disgusting” or “unimportant.” 

It is time to start from scratch. 

Menstruation is simply monthly bleeding that occurs in the female body, famously known as the “period,” or jokingly, “the time of month.” It is the biological flow of blood and tissue, from the shedding of the uterine lining traveling all the way to the cervix and then eventually unleashed through the vagina. Not the vulva. The vulva is the external part of the female genitals while the vagina is the inner muscular channel that connects the vulva to the cervix. 

As a whole, the menstrual cycle is the sequence of events or phases that take place in the body to prepare for pregnancy and reproduction. The normal average length of a menstrual cycle is 28 days. There are four phases: menstrual, follicular, ovulation, and lumenal phases. This guide will explain all of the phases of cycles in the simplest ways possible. 

Menstrual Cycles

Menses Phase

Starting with day one, if pregnancy still has not occurred, the lining of the uterus( endometrium) shreds through the vagina. 

Follicular Phase

This is the first day of the period when estrogen levels increase which leads to the uterine lining growth and thickness 

Ovulation Phase

This is the last day of the period where you ovulate. At this time, estrogen is still on the rise but along the way, there was a sudden rise in another hormone. This hormone is called the luteinizing hormone aids in making the ovary unleash its eggs. 

Luteal Phase

After the eggs get unleashed from the ovary and make their way through the fallopian tubes to the uterus, the level of progesterone begins to increase in the process of preparing the uterine lining for pregnancy. 

Pregnancy will occur if the egg becomes fertilized with sperm and the egg becomes implanted too. However, if not then all levels of hormones will drop and the thick lining of the uterus sheds during the period. 

If you would like to learn more about menstruation and the menstrual cycle in detail then stay tuned for future articles explaining cycles and more detailed information about menstruation. 

References

[1] Parenthood, Planned. “What Is Menstruation?: Get Facts about Having Your Period.” Planned Parenthood, professional.
[2] Cleveland Clinic Medical. “Menstrual Cycle (Normal Menstruation): Overview & Phases.” Cleveland Clinic.

The speculum is often cited as the most uncomfortable part of a gynecologist visit.^[10] It lies at the center of an important preventative health care service: the pelvic exam.^[16] The speculum is a medical instrument that has two arms that meet at a hinge – the arms look similar to a duck’s bill.^[6] The health care provider inserts the speculum into the vagina and opens the speculum to widen the vaginal walls so the provider can view the vagina and cervix more easily.^[6] For many individuals, the speculum causes pain and discomfort.^[4] This is unsurprising given that the modern speculum has remained essentially unchanged since 1870.^[15] In addition, physicians have not yet widely adopted practices that may reduce a patient’s pain and anxiety during the pelvic exam.^[7]

The speculum’s origins may inform some of the issues patients experience today. The modern speculum has a legacy of causing pain: it was invented by James Marion Sims in the 1840s when he conducted experiments on slave women – Lucy, Anarcha, and Betsey – without anesthesia even though it was available at the time.^[12] Needless to say, the speculum was not designed with the patient’s comfort in mind. Sims did not use anesthesia while developing the speculum because he held the erroneous belief that black people did not experience pain like white people did.^[12] In addition, the women were further stripped of their autonomy because Sims only required consent from their owners to conduct the experiments.^[12] Today, around 35% of women* experience pain or discomfort during pelvic exams and about 35% of women experience fear, embarrassment, or anxiety before or during the pelvic exam.^[4] 

The speculum is not specialized enough to be used for all populations who require its use.^[24] Since pain and emotional discomfort are subjective experiences, providers should utilize an individualized approach for speculum insertion and pelvic exams.^[19] As Roger Fillingim, director of the Pain Research and Intervention Center of Excellence at the University of Florida, indicates, “you treat the pain that the patient has, not the pain that you think the patient should have.”^[3] According to various studies, it appears that educating patients about pelvic exams and specula as well as encouraging patients’ personal control during the exam may decrease pain and emotional discomfort.^[8],[19] Informing patients that pain is not normal and informing them of pain management options may improve patient outcomes during pelvic exams as patients can try to mitigate the pain before it occurs.^[20] Given that the pelvic exam places people in a vulnerable position, it makes sense that bolstering the patient’s autonomy could ease the psychological discomfort surrounding the exam.^[9] For example, based on research findings, certain women indicated that they would feel more comfortable with the speculum insertion if their provider informed them of each step of the process or allowed them to look at the speculum before the exam.^[24],[9] Others indicated that they would likely feel more comfortable if the provider gave them the option to insert the speculum themselves.^[2]

While pain and emotional discomfort should be considered for updating the speculum and how it is used, such issues are trivialized when reported by women. Women’s pain is often perceived as an overreaction rather than reality in part because women are more likely to express pain.^[3] More often, physicians prescribe less pain medication for women than for men.^[11]

Providers also seem unwilling to adopt new specula into practice if they have not been rigorously tested because the current speculum is the standard.^[24] There are both economic barriers and social barriers to testing. Historically, women have been excluded from medical research. For example, the National Institute of Health did not require that scientists account for sex as a variable in medical research until 2015.^[22] It also appears that there is a gender bias against studying medical issues that primarily affect women. When analyzing funding allocation among diseases, the United States National Institutes of Health applied a disproportionate portion of its resources to diseases primarily affecting men.^[17] Issues arising from the use of the speculum or updates to the procedure have likely not been addressed or publicized to the majority of the population given that the last general overview of the speculum was published in 2008.^[24] 

In addition to the unwillingness to fund research surrounding speculum updates, doctors may not adopt new tools or updated practices due to cost. The current speculum is inexpensive, rarely needs replacing, and is easy for practitioners to use.^[7] Lack of insurance coverage and limited provider time to see patients may affect the provider’s ability to utilize pain management options or individualized solutions to pain and emotional discomfort.^[7]

By failing to address the physical and emotional harm the speculum causes, women’s health is impacted. For example, while cervical cancer is preventable through regular screenings, researchers have found that the rates of timely cervical cancer screenings for eligible adults have decreased since 2005.^[23] One of the main ways to screen for cervical cancer is through a pap smear, also known as a pap test, during the pelvic exam.^[18] Using the speculum, the health care provider checks for any irregularities and then collects cells from the cervix that are later tested for signs of cervical cancer.^[6] According to data from 2018, only about 51% of women go to the gynecologist at least once per year^[14]. Lack of access to health care remains a significant problem for marginalized groups, especially Black women.^[13] However, lack of access as a reason for being overdue for a cervical screening declined overall.^[23] By contrast, pain continues to be a significant factor in whether people continue seeking cervical cancer screenings.^[13] More specifically, some studies indicate that people refrain from seeking cervical cancer screenings because they have experienced pain during the pap smear in the past.^[13] The decline is screenings is concerning considering the American Cancer Society estimates that there will be approximately 13,820 new cases of invasive cervical cancer diagnosed in 2024.^[1]

In order to improve patient experiences and reproductive health overall, it appears more funding is required for speculum updates. Patients should also be better informed about the speculum and the pelvic exam. Lastly, providers should become zealous advocates for their patients and make their patients feel comfortable undergoing these essential diagnostic procedures. 

*This article uses “women” and “men” when the underlying source uses these categories. This article recognizes that women are not the only population that goes to the gynecologist.

References 

[1] American Cancer Society. (2024, January 17). Key Statistics for Cervical Cancer. Cervical Cancer Statistics. https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html. 

[2] Bergman, S. (2022, June 20). How enduring use of 150-year-old speculum puts women off smear tests. The Independent. Retrieved February 10, 2024, from 

https://www.independent.co.uk/life-style/women/speculum-use-smear-tests-pain-sexism-b21051 11.html. 

[3] Bever, L. (2023, December 13). From heart disease to iuds: how doctors dismiss women’s pain. The Washington Post. Retrieved February 10, 2024, from https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/.

[4] Bloomfield H.E., Olson A., Cantor A., et al. Screening Pelvic Examinations in Asymptomatic Average Risk Adult Women. Washington (DC): Department of Veterans Affairs (US); 2013 Sep. RESULTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224895/ 

[5] Chaney, P. (2020, March 18). Speculum Speculations: The Past and Future of an Iconic Gynecology Instrument. Empowered Women’s Health. https://www.volusonclub.net/empowered-womens-health/speculum-speculations-the-past-and-fut ure-of-an-iconic-gynecology-instrument/#:~:text=The%20speculum%20is%20a%20familiar,unc hanged%20for%20over%20150%20years. 

[6] Cleveland Clinic. (2022, October 3). Speculum. Speculum: Design, Purpose, Types, Exams & What to Expect. https://my.clevelandclinic.org/health/drugs/24238-speculum 

[7] Davenport, E. (2023, June 15). Let’s liberate women from the speculum. The Boston Globe. Retrieved February 10, 2024, from https://www.bostonglobe.com/2023/06/15/opinion/liberate-women-from-the-speculum/.

[8] Domar A.D., Psychological aspects of the pelvic exam: individual needs and physician involvement. Women Health. 1985-1986 Winter;10(4):75-90. doi: 10.1300/j013v10n04_07. PMID: 3832651. 

[9] George, R. (2018, April 23). How to redesign the vaginal speculum. The Guardian. Retrieved February 10, 2024, from https://www.theguardian.com/lifeandstyle/2018/apr/23/how-to-redesign-the-vaginal-speculum.

[10] Haar, E., Halitsky, V., & Stricker, G. (1977). Patientsʼ Attitudes toward Gynecologic Examination and to Gynecologists. Medical Care, 15(9), 787–795. https://doi.org/10.1097/00005650-197709000-00006.

[11] Hoffmann, D. E., & Tarzian, A. J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. The Journal of Law, Medicine & Ethics, 13–27. https://doi.org/10.2139/ssrn.383803.

[12] Holland, B. (2018, December 4). The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women. History.com. https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experimen ts-on-slaves 

[13] Hoyo, C., Yarnall, K. S. H., Skinner, C. S., Moorman, P. G., Sellers, D., & Reid, L. (2005). Pain predicts non-adherence to pap smear screening among middle-aged African American women. Preventive Medicine, 41(2), 439–445. https://doi.org/10.1016/j.ypmed.2004.11.021 

[14] IPSOS Global Advisor. “Global Views On Healthcare.” IPSOS, 2018, www.ipsos.com/sites/default/files/ct/news/documents/2018-07/global_views_on_healthcare_201 8_-_graphic_report_0.pdf. 

[15] Kent, C. (2020, September 10). Does the vaginal speculum need a redesign?. Medical Device Network. https://www.medicaldevice-network.com/features/does-the-vaginal-speculum-need-a-redesign/?c f-view. 

[16] Mayo Clinic Staff. (2023, May 24). Pelvic exam. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135.

[17] Mirin, A. A. (2021). Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. Journal of Women’s Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682

[18] National Cancer Institute. (2023, August). Cervical Cancer Screening. Cancer Trends Progress Report. https://progressreport.cancer.gov/detection/cervical_cancer.

[19] Nudson, R. (2022, June 1). Gynecology Has a Pain Problem Our discomfort is routine. what if it didn’t have to be? The Cut. Retrieved February 10, 2024, from https://www.thecut.com/2022/06/pain-in-gynecology-practice-exams.html.

[20] Oregon Health and Science University. (n.d.). Closing the Gender Pain Gap: Your Gynecologist Has Pain Control Options. Center for Women’s Health. 

https://www.ohsu.edu/womens-health/closing-gender-pain-gap-your-gynecologist-has-pain-contr ol-options. 

[21] Pardes, A. (2017, October 5). The speculum finally gets a modern redesign. Wired. Retrieved February 10, 2024, from 

https://www.wired.com/story/the-speculum-finally-gets-a-modern-redesign/#:~:text=That%20the %20speculum%20is%20old,get%20a%20good%20look%20inside. 

[22] U.S. Department of Health and Human Services. (n.d.). Not-OD-15-102: Consideration of sex as a biological variable in NIH-funded research. National Institutes of Health. https://grants.nih.gov/grants/guide/notice-files/not-od-15-102.html?itid=lk_inline_enhanced-tem plate. 

[23] Winstead, E. (2022, February 22). Why Are Many Women Overdue for Cervical Cancer Screening?. Rate of Overdue Cervical Cancer Screening Is Increasing. 

https://www.cancer.gov/news-events/cancer-currents-blog/2022/overdue-cervical-cancer-screeni ng-increasing#:~:text=Results%20on%20cervical%20screening%20from,2005%20to%2023%25 %20in%202019. 

[24] Wong, K., & Lawton, V. (2021). The Vaginal Speculum: A Review of Literature Focusing On Specula Redesigns and Improvements to the Pelvic Exam . Columbia Undergraduate Research Journal, 5(1). https://doi.org/10.52214/curj.v5i1.8084.