Category: Science

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] 

Symptoms

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] 
  • Gynecological issues such as polycystic ovarian syndrome (PCOS) as well as premature menopause (which is associated with fragile X-associated primary ovarian insufficiency (FXPOI)) are tied to amenorrhea. ^[5][3][4]
• 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.

References

[1] Amenorrhea: Absence of periods. (2020, October). https://www.acog.org/womens-health/faqs/amenorrhea-absence-of-periods

[2] Amenorrhea—Diagnosis & treatment. (2023, February 9). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/amenorrhea/diagnosis-treatment/drc-20369304

[3] Amenorrhea—Symptoms and causes. (2023, February 9). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299 

[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

[5] What causes amenorrhea? | nichd – eunice kennedy shriver national institute of child health and human development. (2017, January 31). https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes

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] 

There are several causes for low libido. 

• 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. 

Biological and Hormonal Factors 

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. 

[5] National Institute on Aging (2023). “Alzheimer’s Disease Genetics Fact Sheet.” U.S. Department of Health and Human Services. Accessed 22 May 2024 . https://www.nia.nih.gov/health/genetics-and-family-history/alzheimers-disease-genetics-fact-sheet

[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]

Symptoms

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]

References

[1] Cleveland Clinic. (n.d.). Endometriosis: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10857-endometriosis 

[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 

[3] Johns Hopkins Medicine. (n.d.). Endometriosis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis 

[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

Why is Depression More Prevalent in Women?

Unnati Shekhar
June 2024

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

Pregnancy is a transformative period in a woman’s life. The excitement that comes with the journey is unparalleled, an astonishing experience for everyone involved. In the miscellany of all of these emotions, good nutrition can easily be overlooked. It has recently been discovered the vitality of good nutrition during this time and how a lack of nourishment can undermine the health of the baby.    

In some underprivileged countries, women’s diets are lacking in main food groups, like dairy and legumes. Since the pandemic, malnutrition in adolescent girls and women has skyrocketed by twenty-five percent, from 5.5 million to 6.9 million.^[1] Malnutrition has severe effects when only one individual is dependent on the body’s nourishment. When two are reliant, the response can be detrimental.  Malnutrition can lead to an increased risk in neonatal death, which is defined by the death of a live-born infant within the first 28 completed days of life.^[1]  It can also impair fetal development with lifelong consequences for children’s nutrition and growth.^[1] However, these are just the effects on the baby. The effects on the mother are just as dangerous.

Vitamins are key in any diet. From iron to calcium, these nutrients are building blocks for exceptional health. Poor diet during pregnancy is represented with reduced levels of necessary vitamins, like iodine, iron, folate, calcium and zinc.^[2] This can often lead to anemia, preeclampsia, hypertension and more.^[2] Disease is a less harsh repercussion of this loss. Malnourishment leads to double the chances of maternal mortality.^[2] There are many elements when thinking about malnutrition in pregnant women like a lack of resources, prior health detriments and furthermore. These factors are out of one’s control and are not at all the fault of the mother . There are few and far between programs to help mothers sustain themselves and to aid with good maternal nutrition. It is vital for the health of children and women globally that there are more of these programs instituted as the malnourishment crisis continues to grow.  

We see the harms of malnutrition. But what can a good diet do for mothers and their babies? A well-balanced diet, rich in legumes, proteins, grains and healthy fats aid the immune system and reduce inflammation.^[4] Physiological changes and stressors can be a lot for women to bear during pregnancy, however this benefit makes it easier for them to cope with the adaptations. It also helps regulate blood glucose, weight fluctuations etc.^[4] Good nutrition can aid a pregnancy tremendously, making the process easier and less stressful for mothers.

Maintaining good nutrition during pregnancy has a few requirements. Eating nutrient-dense foods, smaller meals, staying hydrated and limiting processed food can ensure mothers getting the key nutrients to keep them and their babies healthy.^[3] If available, consulting with a healthcare provider or dietician is always a beneficial way of ensuring that your diet is in check. 

By eating healthily, pregnant women can enhance the health of themselves and their children. Empowering expectant mothers with the knowledge and resources to make informed dietary choices goes hand in hand in promoting positive birth outcomes and ensuring a healthy start for both mother and baby.

References

[1] Malnutrition in mothers soars by 25 per cent in crisis-hit countries, putting women and newborn babies at risk. UNICEF. (n.d.). https://www.unicef.org/press-releases/malnutrition-mothers-soars-25-cent-crisis-hit-countries-putting-women-and-newborn 

[2] Marshall, N. E., Abrams, B., Barbour, L. A., Catalano, P., Christian, P., Friedman, J. E., Hay, W. W., Hernandez, T. L., Krebs, N. F., Oken, E., Purnell, J. Q., Roberts, J. M., Soltani, H., Wallace, J., & Thornburg, K. L. (2022, May). The importance of nutrition in pregnancy and lactation: Lifelong consequences. American journal of obstetrics and gynecology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9182711/ 

[3] Nutrition during pregnancy. Johns Hopkins Medicine. (2019, November 19). https://www.hopkinsmedicine.org/health/wellness-and-prevention/nutrition-during-pregnancy [4] Shenoy, S., Sharma, P., Rao, A., Aparna, N., Adenikinju, D., Iloegbu, C., Pateña, J., Vieira, D., Gyamfi, J., & Peprah, E. (2023, October 25). Evidence-based interventions to reduce maternal malnutrition in low and middle-income countries: A systematic review. Frontiers in health services. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10634505/#:~:text=Shockingly%2C%20malnourished%20women%20face%20a,in%202020%20occurred%20within%20LMICs.