(Reuters Health) – The AbbVie drug elagolix, already used to treat the pain of endometriosis, can significantly reduce the chances of heavy menstrual bleeding caused by uterine fibroids, according to the results of two studies reported in The New England Journal of Medicine.

Uterine fibroids are non-cancerous growths in the uterus that can cause problems such as pain, pressure, heavy periods and infertility in as many as half the women who have them. They are very common, particularly among African American women.

The elagolix treatment, if approved by the U.S. Food and Drug Administration, could give women a new option for dealing with the bleeding. Current treatment sometimes involves injections given monthly or every three months. Elagolix is a pill whose effects appear and fade much more rapidly and predictably. The new studies did not directly compare the two treatments.

“This does provide a different approach and many women may prefer that,” lead study author Dr. William Schlaff of Thomas Jefferson University in Philadelphia told Reuters Health in a telephone interview. “We know it’s effective for at least six months. If that can be prolonged, it could act as a bridge to get to menopause, where hormone levels drop naturally.”

“But if you’re 32 years old (with a fibroid bleeding problem) this may not be a bridge you want to use for 20 years,” he said. Such women may want to consider a hysterectomy or some other option.

The two new studies – which were identical – followed a total of 790 women with a menstrual blood loss of more than 80 milliliters (about 2.7 ounces) per month.

At the six-month mark, among women getting placebo treatment, 8.7% in one study and 10% in the other saw their monthly blood loss reduced by at least 50%.

When the women were given elagolix alone, the success rates were 84.1% in one study and 77% in the other.

The treatment suppresses ovarian sex hormones, increasing the odds of osteoporosis. So in some women, doctors also gave hormone therapy to compensate.

With that hormonal “add-back therapy,” monthly flow was still reduced by at least 50% in 68.5% of women in one study and in 76.5% in the other.

Add-back therapy alleviated decreases in bone mineral density caused by elagolix but it also increased the number of hot flushes in both trials, and in one trial, it increased the likelihood of spotting between periods, the researchers found.

Most side effects of the drug “were considered by the investigators to be mild or moderate in severity,” they reported.

The studies, known as Elaris UF-1 and Elaris UF-2, were financed by AbbVie, which sells the drug under the brand name Orilissa.

The 300-milligram twice-daily elagolix treatment would cost more than $47,000 per year, according to prices on goodrx.com. In contrast, monthly leuprolide injections, which are an established treatment, costs roughly $7,000 per year.

Compared with placebo recipients, elagolix recipients with add-back therapy also had higher levels of the oxygen-carrying protein hemoglobin in their blood and were more likely to have their periods cease altogether.

They also tended to score higher on quality of life questionnaires.

Schlaff, who chairs the department of obstetrics and gynecology at Thomas Jefferson, predicted that if the drug is approved for fibroid bleeding, it will change the way women are treated.

“A lot of women want to use oral medication” instead of periodic injections, he said. “Women are going to say, ‘I don’t want to commit to a 1- or 3-month dose.’ Or they may want to start with one and move to another.”

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These are all symptoms more commonly associated with endometriosis – which is when tissue that lines the uterus grows on other pelvic organs.

But it might actually be the lesser-known “ugly sister” to the agonising condition – adenomyosis.

Both conditions share similar symptoms and women can have both at the same time, they’re caused by different issues.

Affects 1 in 10

Adenomyosis happens when the bits of tissue that line the uterus – known as the endometrium – grows into the muscle layer of the womb.

Like endometriosis and PCOS, it is thought to affect 1 in 10 women.

It can cause feelings of fullness or bloating which means women with the condition are often misdiagnosed as having irritable bowel syndrome (IBS).

As it can lead to excess bleeding, women are also at risk of becoming anaemic.

Consider diet

Gynaecologist Dr Anita Mitra says although there have been no studies looking into the link between diet and adeno, what you eat is still important in managing the symptoms.

If you’re bleeding loads, you need to make sure that you’re really stocking up on fibre and leafy green veg.

She told Stylist: “Why is that? So that you can do a good poo to help your body excrete the old oestrogen that it doesn’t need, as well as preventing constipation which could be worsening the pain of adenomyosis by putting extra pressure on your already inflamed uterus.

“My advice would be to keep a symptom diary if you think there’s a particular food that is affecting your symptoms, but seek advice from a nutrition professional before you seek to cut out entire food groups to make sure that you aren’t running into nutrient deficiencies. “

Keep a symptom diary if you think there’s a particular food that is affecting your symptoms

She also stresses that despite the fact that hysterectomies are often promoted as a cure for the condition, they definitely shouldn’t be your first thought.

Painkillers, oral contraceptive pills and the Mirena coil are all primary options.

Because the cause of the condition is still unknown, there’s not a lot out there other than hormonal treatments and very invasive surgeries.

Dr Mitra stresses that the initial options can be “quite life-changing for many women”.

They work by reducing the monthly thickening and shedding of the uterus – which is the main source of pain experienced by adenomyosis sufferers.

Unlike endometriosis, which can only be definitively diagnosed through a key-hole surgery, a diagnosis of adenomyosis can be done through both invasive and non-invasive methods.

The most common invasive method is a uterine biopsy (tissue sampling).

A biopsy of the uterus can also be performed to make the diagnosis by an abdominal key-hole surgical procedure (laparoscopy) but this remains limited to clinical trials.

Damaging

Biopsies going through the vagina up to the uterus may have a role in the diagnosis of adenomyosis, but can potentially damage the uterus and therefore are avoided in women wishing to fall pregnant.

Ultrasound is also commonly available and can be done either using the probe on the abdomen or, preferably, placing the probe in the vagina.

However, ultrasound isn’t always the best choice as it only detects adenomyosis about 50-87 per cent of the time.

Magnetic resonance imaging (MRI) is a better choice as there are a number of typical features seen during MRI.

These vary throughout the cycle and in response to hormonal therapy but can reliably predict adenomyosis.

There is some evidence adenomyosis can reduce fertility, but this is still controversial.

Clinical studies are limited by difficulties and differences in diagnosis and their study designs have problems.

Some MRI studies show changes consistent with infertility, but because patients presenting with infertility in their 30s and 40s are more likely to be diagnosed with adenomyosis, it’s difficult to say if adenomyosis is the cause of their fertility issues.

When couples are undergoing assisted reproduction (such as IVF) there is limited evidence to support a negative impact on oocyte and embryo quality, implantation and pregnancy rates.

Overall, there appears to be limited negative impact of adenomyosis on allowing the embryos to implant or overall pregnancy rates.

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For years, Shelby* would get a pain in her lower abdomen around once a month. It didn’t happen during her period – but it did kind of feel like period pain. The pain would last for around six to eight hours and was a “sharp, stabbing pain,” Shelby says.

One month, the pain would be on her left. The next month, she’d feel it on her right. It wasn’t until Shelby started using a period tracker app about ten years ago that she realised that the pain she was having coincided with ovulating.

In other words, she discovered she experiences mittelschmerz.

What is mittelschmerz?
If you haven’t heard of mittelschmerz, you’re not alone. Though it’s a mouthful, it’s actually a German word meaning ‘middle pain’. While it can feel like period pain, mittelschmerz is actually due to ovulation pain. In case you’re not up to date on all the technicalities of ovulation, ovulation is when the ovary releases an egg. That egg then can be fertilised, if you get pregnant.

According to Better Health Channel, approximately one in five women experience pain during ovulation. In the majority of cases, as with Shelby, it doesn’t mean there’s anything’s wrong.

What does mittelschmerz, or ovulation pain feel like?
Mittelschmerz is often felt around the area of the ovary, meaning either to the left or right of the midline of the abdomen, down low. The pain can be felt as pressure, sharp pain, a twinge or cramps. It can pass in a matter of minutes, go for a few hour or may even last for a couple of days.

Why does ovulation pain happen?
According to Better Health Channel, there are two main theories as to why ovulation can be painful for some women. One theory relates to the pressure of the follicle (which contains the egg) stretching the ovary.

The other theory relates to the bursting of the follicle. You see, when the egg is mature, it bursts out of the follicle and can cause a bit of bleeding. That bleeding can then irritate parts of the stomach lining, which can be painful.

What can I do to ease ovulation pain?
In most cases, the pain of mittelschmerz isn’t too bad, so you might not need to do anything to help treat it. If you do need some extra help, you can try using a hot pack, doing some gentle stretches, or reaching for some simple painkillers like paracetamol or ibuprofen (if you don’t have any reasons that you can’t use them).

In other words – you can try the same kinds of stuff you’d reach for if you had period pain.

Help! My mittelschmerz is awful! What should I do?
If you suffer from severe pain in between your periods, it’s definitely worth seeing your GP. That’s because you could have something else that’s causing your pain.

For example, you might have an infection of the fallopian tubes (called salpingitis), endometriosis, or another pelvic or abdominal issue. If that’s the case, you need to make sure you receive a proper diagnosis, investigations and treatment if needed.

Lastly, if the pain of mittelschmerz is ever super-intense, continues for longer than a couple of days, or is associated with unusual symptoms such as heavy bleeding from down below, you should also see your doctor.

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SABIN, Minn. — She’s the familiar voice on WAVE 104.1, but there’s something about Natalie Burbeck that many listeners can’t hear.

Burbeck knew from a young age her body was experiencing something different from other girls.

“I mean, you would talk with girlfriends about things and you find out, okay, they have these symptoms and you feel like yours are so much worse,” she says.

Menstrual cycle cramps were intolerable.

“They were to the point where I was miserable.”

Major headaches, constant fatigue and extreme pain told her something was off.

It wasn’t until three years ago, when her symptoms started to worsen, that she decided it’s time to do something about it.

But multiple visits to different doctors gave her zero answers.

“I doubted that anyone believed me. That — I was like, ‘Am I going crazy?’ I know something is wrong here.”

It wasn’t until she did her own research and found the right physician at Sanford Health that things started to look up.

“When I found Dr. Coauette, I explained to her, I had done all this research on Endometriosis and I said, ‘I really do believe that it is this,’ and she was the first doctor that really believed in me and was like, ‘We’re going to get to the bottom of this. We’re going to figure this out.’”

Endometriosis, often referred to as the “Silent Disease,” affects 1 in 10 women, but it’s rarely talked about.

“Mostly because those symptoms are so common in women with your period. It’s your period. And a lot of women don’t talk about it, so you just, your mom says, ‘Yeah, I had bad cycles. I took Motrin and moved on,’” says Sanford OBGYN Dr. Jordan Coauette.

It’s a disorder in which tissue that normally lines the uterus grows outside of it.

Although there’s no permanent cure for Endometriosis, a laparoscopy removes as much of that tissue as possible.

“I was super scared about the surgery, but it was very easy and I feel great afterwards. The recovery was so easy. I had surgery over a year ago and I feel really good,” says Burbeck.

The lesson she’s passing on to other women is to simply listen to their bodies.

If you think something is wrong…

“I recommend seeing your primary care, seeing one of us OBGYN’s and just telling us what’s going on. Tell us your story,” says Dr. Coauette.

They say talking about it is the first step to getting a solution.

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The painful symptoms of endometriosis – a chronic condition which affects millions of women – could potentially be reduced with a drug that had previously been investigated as a cancer treatment.

Researchers found that using dichloroacetate to treat the cells of women with endometriosis lowered the production of lactate – a potentially harmful waste product – and stopped abnormal cell growth.

Endometriosis – which affects 176 million women worldwide – is caused by the growth of lesions made up of tissue similar to the lining of the womb in other parts of the body, such as the lining of the pelvis and ovaries.

Researchers from the University of Edinburgh found that cells from the pelvic wall of women with endometriosis have different metabolism compared to women without the disease. The cells produced higher amounts of lactate similar to the behavior of cancer cells.

When the cells from women with endometriosis were treated with dichloroacetate, they were found to return to normal metabolic behavior. The scientists also noted a reduction in lactate and an impact on the growth of endometrial cells grown together with the pelvic cells.

Further tests on a mouse model of endometriosis found, after seven days, a marked reduction in lactate concentrations and the size of lesions.

This research was funded by the charity Wellbeing of Women, and supported by PwC and the Medical Research Council UK.

Currently available treatments for endometriosis are either hormone-based, which can produce unpleasant side effects, or surgery, which in half of cases, results in lesions returning after five years.

The researchers believe these new findings could help alleviate endometriosis in women who cannot – or do not wish to – take hormonal treatments or prevent recurrence after surgery. The team are conducting an early phase clinical trial to confirm their findings.

This research is published in the Proceedings of the National Academy of Sciences.

Wellbeing of Women aims to saves and transforms the lives of women and gives babies the best start in life by finding cures and treatments across the breadth of female reproductive health, including overlooked areas like endometriosis.

Lead Researcher, Professor Andrew Horne, MRC Centre for Reproductive Health at University of Edinburgh, said: “Endometriosis can be a life-changing condition for so many women. Now that we understand better the metabolism of the cells in women that have endometriosis, we can work to develop a non-hormonal treatment. Through a clinical trial with dichloroacetate we should be able to see if the conditions we observed in the lab are replicated in women.”

Janet Lindsay, CEO of Wellbeing of Women said: “More than 176 million women suffer from endometriosis yet few people have heard of it and treatment, which can impact fertility, has progressed very little for over 40 years. This is why we are so excited by the findings of this research that Wellbeing of Women has funded and which could lay the basis for the first new non-hormonal treatment offering women a life-changing option. We are delighted that Professor Andrew Horne’s new treatment going to clinical trial could hugely impact so many women’s lives.”

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The World Endometriosis Organisations (WEO) was recently officially launched, with the goal of improving health outcomes for the roughly 200 million patients with endometriosis worldwide, as well as to address major issues affecting them.

With 27 member organizations across the world, the WEO is affiliated with the World Endometriosis Society (WES), which advances evidence-based standards and innovations for education, advocacy, clinical care, and investigations in endometriosis, in collaboration with global partners. The newly established WEO encourages organizations to join WES.

WEO arose from the WES 2017 World Congress on Endometriosis, where stakeholders decided to establish a global network of organizations that emphasizes collaborative efforts in advocacy, education, research, enhanced caregiver support, and better awareness and understanding of the disease that affects 1 in 10 females of reproductive age.

Each year, WEO member organizations must establish and work toward goals in their respective countries. The primary WEO goal this year is to heighten awareness of endometriosis in young people.

“While the disease has plagued people for centuries, it has been swept under the carpet, overlooked in importance and usually given little or no priority in health sectors around the world,” founding principal Deborah Bush, CEO of Endometriosis New Zealand, said in a press release. “Worse still, the disease starts young — often from a child’s first menstrual period — and it can have a debilitating effect on schooling, careers, relationships, everyday function and fertility.”

Kathleen King, chairwoman of the Endometriosis Association of Ireland, said the WEO has the potential to make a meaningful impact.

“For too long, endometriosis has been misdiagnosed and misunderstood,” she said. “Coming together under a strong body like the WEO will allow us to educate, advocate, and represent those living with endometriosis. This partnership ensures a high standard of information being shared with all those involved in the care, research and support of endometriosis.”

Abeesha Toussaint, chairwoman of the Trinidad and Tobago Endometriosis Association, called for a continued structured approach in getting more professionals involved in improving health outcomes and patients’ life quality.

“Patients’ stories seem most profound as there is increased awareness of varying signs and symptoms of endometriosis,” she said. “However, in this context, increased awareness does not equate with improvement in health outcomes for endometriosis patients. They still suffer at the hand of this disease — ineffective and often outdated treatment, significantly reduced quality of life, chronic pain, sub-fertility and infertility, exhausted financial resources, and high absenteeism at schools and workplaces.”

According to Bush, the disorder causes 27% of school-age patients to miss classes on a nearly monthly basis, a figure she called “scandalous.”

For her part, Asdis Bragadottir, treasurer of the Endometriosis Association of Iceland, lamented the more than eight years it usually takes for patients to be diagnosed, mostly because disease symptoms mimic other disorders. The delay puts patients who aren’t being treated at risk of infertility, she said.

“Some drop out of school and others lose their job due to too many sick days. This delay is not acceptable and needs to be addressed by health officials all over the world,” she said.

WEO’s steering committee includes members of endometriosis organizations from Ireland, Iceland, New Zealand, and Trinidad and Tobago. Its 27 member organizations are in Romania, Barbados, Hungary, Australia, France, Finland, Norway, Sweden, Belgium, the Maldives, the United States, Ghana, Kenya, the Netherlands, Nigeria, the United Kingdom, Canada, and Turkey.

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According to the Endometriosis Foundation of America, at least 200 million women worldwide have endometriosis. That’s one in every ten people with uteruses (including me).

The disorder is classified as an estrogen-dependent chronic inflammatory disease that affects women starting at reproductive age. Because it’s a female pain disorder, the cause is entirely unknown.

Tissue similar to the uterine lining grows outside of the uterus, causing painful lesions and numerous highly disruptive symptoms. From pelvic pain, nausea, brain fog and fatigue to lower back pain and chronic abdominal pain; it literally won’t leave you alone.

Even worse, it takes the average person nine years to get diagnosed with endometriosis. Even with diagnosis, there’s no cure for the condition so you’re fairly stuck for options.

Many women choose birth control pills or an IUD to try and reduce the symptoms, but even with excision and ablation surgery, the disorder will keep on regenerating. 

Surgical removal of the lesions and hormonal contraception can help, but you’re never free from it’s grip. Some women have horrific symptoms but very few lesions, making it even harder to understand.

Noemie Elhadad, a professor of Biomedical Informatics at Columbia University, decided to study data sets on the disease, discovering a shocking dearth of information.

Speaking to HuffPost, she said; 

“It’s frustrating because there’s really not a whole lot of solutions out there. Treatments are available, but we don’t know who yet who will respond in which way to what treatments. There’s still a whole lot of experimentation required and it’s really a burden on the patient.”

Elhadad’s own frustration with endometriosis coupled as well as her research on the intersection of technology and medicine spurred her to look further into the matter.

“There’s not tonne of documentation in medical claims about how many surgeries women experience for endometriosis and what type of surgery is done for them, for example. It felt like we were missing actual relevant data to study better the disease.”

That need for data led Elhadad to create Phendo, an app which allows sufferers to track their endometriosis symptoms, treatments and pain-management strategies.

“I want to change the mental model of the way the disease is diagnosed,” states Elhadad. Herself and other researchers asked patients directly to share their experiences to build a catalogue of symptoms.

Phendo has over 6,000 participants globally who engage and track their symptoms on the app, creating helpful data for scientists and medical researchers. 

It’s also a means to educate women so they can adequately advocate for themselves at the doctor’s office, which can be an intimidating place.

“There’s a lot of evidence by now of gender biases in healthcare where women in general are not being heard when they talk about their symptoms,” said Elhadad.

The app “can show in a very nearly mathematical way, a graph of this is how your pain has been in the past few months, it feels like an accurate description and something that feels so objective about who they are and hopefully a way to get heard.”

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You’ve probably heard of endometriosis, a gynecological condition that can cause women to have debilitating pelvic pain, excessive bleeding, bloating and infertility. But did you know that it has a lesser-known sister condition called adenomyosis?

Adenomyosis likely affects millions of women, but it’s not well understood. The knowledge base is growing, though, and medical experts are coming to better understand how to effectively diagnose it and help women manage it.

“It used to be thought that adenomyosis only occurred in older women, but it’s now being diagnosed earlier,” says Rosanne Kho, MD, Head of the Section of Benign Gynecology and a subspecialist in minimally invasive gynecologic surgery. That’s probably because gynecologists have better tools than ever to diagnose it, she suggests.

There’s still much to learn about this condition. But it’s understood that it can deeply affect a woman’s quality of life — and potentially her fertility.

“Adenomyosis is getting much more attention now,” Dr. Kho says. “Hopefully in the next few years we will be able to understand this condition better.”

Endometriosis and adenomyosis

Endometriosis and adenomyosis can cause some of the same symptoms, but what’s happening inside the body isn’t quite the same. And a woman could actually have both.

In endometriosis, some of the tissue that lines the inside of the uterus travels outside of the uterus, attaches itself to other pelvic organs and continues to bleed monthly. In adenomyosis, that tissue instead embeds itself inside the wall or muscle of the uterus, causing the uterus to swell.

Some women don’t have any symptoms, but many who are eventually diagnosed with adenomyosis are tipped off that something is wrong because of heavy periods and agonizing pain, Dr. Kho says.

Doctors used to only be able to make an adenomyosis diagnosis after a woman had her uterus removed to get rid of her symptoms, and a pathologist could see that there was indeed endometrial tissue inside the walls of her uterus.

But thanks to greater awareness of the condition and improvements in diagnostic tools like transvaginal ultrasound and MRI imaging, gynecologists can now see signs of the disease in women who haven’t had a hysterectomy.

It’s hard to know how many women have this condition, and experts aren’t sure exactly what causes it. But some think that women who have been pregnant or had surgery on their uterus are at higher risk, Dr. Kho says.

Secondary effects

Adenomyosis is not fatal, and symptoms often go away after menopause. However, research has shown that the presence of adenomyosis does elevate a woman’s risk of endometrial and thyroid cancers.

Because it causes changes in the uterus itself, experts also suspect that adenomyosis can make it harder for a woman to get pregnant. But research on this has been limited — and complicated by the fact that adenomyosis often occurs hand-in-hand with other factors that affect a women’s fertility, such as fibroids and endometriosis.

Treatment approaches

Today there are several ways doctors can treat adenomyosis, including options that preserve the uterus for women who still wish to have children.

Which approach is best depends on a woman’s symptoms, whether she wants to have children and the extent of the adenomyosis.

Over-the-counter, anti-inflammatory medicines are the first step in helping with the pain. Beyond that, progestin-only hormonal therapies like an IUD may also ease pain and bleeding — or eliminate periods all together, Dr. Kho says. Other forms of hormonal therapies such as birth control pills, patches or rings, may also be recommended.

If medication isn’t able to decrease symptoms, women may consider other options:

• Endometrial ablation: This minimally invasive procedure that destroys the lining of the uterus may produce good results when the misplaced endometrial tissue occurs in a cluster. When the tissue is spread out or extensive, it may be able to be treated this way if it is not embedded deeply in the walls of the uterus.
• High-intensity focused ultrasound ablation: HIFU is a relatively new treatment that seems to be a promising noninvasive option for patients, Dr. Kho says, but there haven’t been enough comparative studies showing its efficacy, safety and outcomes on pregnancy just yet.
• Surgical removal: A surgeon can remove the affected areas of the uterus, but it’s not going to be perfect. “We would often end up excising healthy tissue and/or leaving some diseased tissue behind,” Dr. Kho explains. “Removing good tissue could put the patient at risk for worse pregnancy outcomes such as uterine rupture.”
• Hysterectomy: Removal of the uterus eliminates adenomyosis but also eliminates the chance for pregnancy.

Steps to take

If you have periods that are heavy or painful, or experience pelvic pain when you’re not on your period, talk with your Ob/Gyn. Any number of things could be going on, so it’s best to get to the bottom of it ASAP.

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I have lost count of the number of times I have heard women around me say “I don’t want to put hormones in my body if I can help it” when talking about contraception or trying to manage heavy periods, PMS or conditions like PCOS or endometriosis. But where does this fear come from?

Yes, there are many known side-effects to hormonal treatments (weight gain, skin problems, mood disturbance, gut issues) like the pill, and it can make some women feel awful. Others won’t feel anything. We also know that, because options are limited when it comes to women’s health (thanks to a systematic lack of funding for research), doctors often put women on hormonal medication in a leap of faith, hoping it will help. However, no two bodies will ever react in exactly the same way. It is important we remember that hormonal contraceptives can also be a godsend for some women – particularly as the wellness industry continues to expand and decry “traditional” medical intervention, a narrative that, if bought into, could potentially stop women finding relief.

I am about to try the combined pill again for the first time since I was 19, in an attempt to control cyclical pain (among other delightful symptoms) that is finally, after 12 years, being tentatively diagnosed as endometriosis – a condition for which the contraceptive pill is a first-line treatment option. I have tried all manner of hormonal interventions in the past – the Mirena coil, the mini-pill, oestrogen gel – in an attempt to control pain and psychological discomfort. I didn’t get on with any of them, but I strongly suspect that my subconscious aversion to taking anything “hormonal” had something to do with how I contemplated the experience. At this point I am willing to try what a kind, experienced gynaecologist suggests, because the pain gives me no other option.As Alexa Chung Shares Her Diagnosis, Here’s Everything You Need To Know About Endometriosis

The pervasive idea – that I bought into for some time – that our bodies should be as “pure” and “drug free” as possible is dangerous. In fact, I think it is one of the worst societal subtexts that pits women against each other. The common idea that there is nobility in being the woman who doesn’t need drugs; who’s had hardly any medical intervention; was the champion who gave birth drug-less, carries potential harm. The thought of there being women suffering with spirit-curdling pain each month and being dead-against taking a medication that might help because it isn’t “right” or “natural”, makes me very sad indeed.

The contraceptive pill is recommended by NICE as a treatment because it continues to have a good evidence base. Again, some women tolerate it better than others. Due to the huge differences in physiology from one woman to the next, we don’t know whether it will work for us until we try it. But trying what’s available to us is precisely what we should be encouraging women who are suffering to do – just as we should be encouraging basic diet and lifestyle changes. (Smokers have an increased risk of having bad period pain, for example.) If we are in pain and are well-informed about our options, nothing that has an evidence base should be off the table.

The language around this fear of hormones really interests me. We often reject the notion of putting “hormones” – the word imbued with a certain dirtiness – into our bodies… as if hormones aren’t what keep us alive. Perhaps it’s the idea of foreign agents – synthetic versions of what we naturally have that supposedly make us fat, mad and sad sometimes. But this growing fetishisation of “natural” – keeping our bodies as “clean” and pure as possible – has capitalised on our fears and been marketed to us as an ideal to make money from us.

There has been a powerful shift in the way women conceptualise and treat their health. According to figures from the Global Wellness Institute, the global wellness industry grew 10.6 per cent from 2013 to 2015: from $3.36 trillion to a $3.72 trillion market. It is easy (and sensible) to scoff at anyone in the wellness industry making dubious, cure-all claims, but we need to think about why these claims have so much power.

As many have argued, women in the Western world have created their own alternative healthcare system in clear response to being routinely dehumanised and dismissed by the medical establishment. Only, promises from wellness “practitioners” often have foundations of sand. “Clean” is a particularly pernicious term, for example, because while regulatory bodies have started to watch companies using “natural” as a marketing tool much more closely, “clean” is far more nebulous, less open to challenge.

There is no value in living in pain, no virtue in suffering. If we are encouraging women to be open about the realities of inhabiting their bodies, let’s encourage them to be properly informed, ask more questions from caregivers about what might help, and do away with this bogus idea of “purity”. A woman should be able to take whatever she has found gives her some peace of mind and body without feeling guilty.

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