Pinched Nerves: The Little-Known Symptoms Everyone Needs To Know

It’s never particularly fun to injure yourself, but as you get older, it takes longer and longer for your body to heal from an injury. One common injury people experience as they age is a pinched nerve. People have nerves throughout their entire bodies, but once in a while those nerves can become pinched — it’s painful and uncomfortable, but there’s often simple treatments for them. WebMD explains, “Nerves extend from your brain to your spinal cord, sending important messages throughout your body. If you have a pinched nerve (nerve compression) your body may send you warning signals such as pain… Damage from a pinched nerve may be minor or severe. It may cause temporary or long-lasting problems. The earlier you get a diagnosis and treatment for nerve compression, the more quickly you’ll find relief. In some cases you can’t reverse the damage from a pinched nerve. But treatment usually relieves pain and other symptoms.” What Does It Mean For A Nerve To Be "Pinched"? The phrase “pinched nerve” gets thrown around by doctors and medical professionals a lot, but what exactly does it mean? According to WebMD, “A pinched nerve occurs when there is ‘compression’ (pressure) on a nerve.” How Do Nerves Become Pinched? According to Mayo Clinic, “A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles or tendons. This pressure disrupts the nerve’s function, causing pain, tingling, numbness, or weakness.” WebMD explains, “The pressure may be the result of repetitive motions, or it may happen from holding your body in one position for long periods, such as keeping elbows bent while sleeping. Nerves are most vulnerable at places in your body where they travel through narrow spaces but have little soft tissue to protect them.” Pinched Nerve Symptoms Pinched Nerve Symptom #1: Radiating Pain From The Source Having a pinched nerve can cause a lot of pain in various areas. One of the most common symptoms is pain that radiates from the source. If you have a pinched nerve in your neck or shoulder, you may feel “pain, numbness, and tingling that radiates from your neck down your upper back, shoulders or arms.” If you have a pinched nerve in your back, you may feel “back pain radiating from your lower back running down your legs. Pinched nerves are most common in the lower back because the lower back bears a high percentage of pressure and force.” Pinched Nerve Symptom #2: Numbness, Tingling, Or "Pins And Needles" According to Dr. Axe, “You might experience pins and needles” if you have a pinched nerve. Like the pain, numbness and tingling can radiate from the source of the pinched nerve. When it comes to pinched nerves in the back, “burning sensations, tingling, heat, and weakness might be felt in the thighs, low back or buttocks. Sometimes the pain might spread upward to your chest and neck.” Pinched Nerve Symptom #3: Weakness And Loosened Grip If your pinched nerve is in your neck or shoulder, “your grip may become weak, and your arm or hand might become stiff.” Elsewhere, you may experience muscle weakness in the area, according to the Mayo Clinic. Pinched Nerve Symptom #4: Worsened Pain From Both Activity And Sleeping Although it may seem counterintuitive, pinched nerve pain can get worse from both increased activity as well as sleep. WebMD explains, “Sometimes symptoms worsen when you try certain movements, such as turning your head or straining your neck.” Additionally, “Pain likely gets worse if you exercise, after waking up from sleeping, or when you’re bending and walking,” according to Dr. Axe. Pinched Nerve Treatments Pinched Nerve Treatment #1: Talk To Your Doctor The first step in treating a pinched nerve is meeting with your doctor. Dr. Axe explains: To help make a diagnosis of a pinched nerve, your doctor will likely perform: a physical exam, testing reflexes, tenderness and pain; assessment of your medical history, family history and injuries; tests for muscle strength or weakness, testing for signs of muscle atrophy, twitching, numbness; testing pain based on motion, touch and pressure; testing joint dysfunction through moving your limbs and torso; diagnostic tests, including CT scan or magnetic resonance imaging (MRI), to look at disc alignment and configuration. Doctors may then prescribe a variety of treatments, including surgery, steroids, and pain relievers. Pinched Nerve Treatment #2: Get Enough Collagen There are also a variety of natural treatments for pinched nerves that you can try at home. The first of these treatments is a collagen repair diet. Dr. Axe explains that collagen helps repair damaged tissue, which can cushion spaces between bones and joints and lead to reduced pressure and friction. Some foods that contain collagen are bone broth, marshmallows, Jell-O, and other foods with gelatin. Pinched Nerve Treatment #3: Opt For Foods With Antioxidants Antioxidants and other foods with anti-inflammatory properties can help the effects of aging, reduce oxidative stress, and supply minerals and vitamins that can help your body recover, explains Dr. Axe. Some foods that are rich in antioxidants and anti-inflammatories are organic fruits and veggies, and herbs like ginger, garlic, and turmeric. Pinched Nerve Treatment #4: Get Your Omega-3s Dr. Axe explains, “Eating omega-3 foods, such as wild-caught fish like salmon, grass-fed beef, chia seeds and flaxseeds, helps naturally control inflammation and reduce the effects of aging.” Pinched Nerve Treatment #5: Correct Your Posture Making your posture better can relieve a lot of pain caused by a pinched nerve. Often times, the only treatment required for a pinched nerve is “simply resting the injured area and avoiding any activities that tend to worsen your symptoms,” explains WebMD. Dr. Axe writes, “Proper posture is crucial for helping take unwanted stress off of delicate joints, especially joints that have been injured or under increased pressure for a long time.” A physical therapist can help with your posture by teaching you ways to relieve pressure on certain parts of your body. They can also help strengthen your core, taking away pain.

What is Female Genital Mutilation and Where Does it Happen?

FGM is thought to affect up to 140 million women and girls, and is recognised as a violation of human rights In Somalia, 98% of young girls suffer female genital mutilation. Thursday 6 February 2014 07.00 GMTFirst published on Thursday 6 February 2014 07.00 GMT Between 100 million and 140 million women and girls are thought to be living with the consequences of female genital mutilation, according to the World Health Organisation. FGM is defined by the WHO as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons". It is recognised as a violation of the human rights of women and girls. In December 2012, the United Nations general assembly unanimously voted to work for the elimination of FGM throughout the world. "It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women," says the WHO. "It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death." Just how many girls and women have been subjected to FGM is hard to know. The data is not easy to collect for obvious reasons. Last year Unicef published what it described as the most comprehensive compilation of data and analysis on the prevalence of FGM in Africa and the Middle East. Using more than 70 national surveys, produced over a period of more than 20 years, the report focused on the 29 countries where the practice is most common. In eight countries, almost all young girls are cut. In Somalia, the prevalence is 98%, in Guinea 96%, in Djibouti 93% and in Egypt, in spite of its partly westernised image, 91%. In Eritrea and Mali the figure is 89% and a prevalence of 88% was reported in both Sierra Leone and Sudan. In some countries, FGM has been medicalised. In Egypt, most of the cutting is undertaken by trained healthcare professionals, which reduces the risk of infection, pain and bleeding, but serves to make the procedure appear acceptable within the country, in the face of the UN resolution. But in countries where more than one survey has been done, it does appear that the number of girls who have been cut is slowly reducing. The UN population fund and Unicef, the UN children's fund, say 8,000 communities in Africa have agreed to abandon the traditional practice. They have been involved in supporting awareness of the health and human rights issues, in negotiations and discussions with the leaders of the communities and in suggesting alternative rituals. Where this process is successful, the social status and marriage prospects of young girls are not damaged as they could be if their families acted alone. In some countries, FGM is a rite of passage, which marks a girl's transition to womanhood and her readiness to marry. It is also motivated by beliefs about sexual behaviour and virginity and chastity. "FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist 'illicit' sexual acts. When a vaginal opening is covered or narrowed [as is the case in the more extreme forms of FGM], the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage 'illicit' sexual intercourse among women with this type of FGM," says the WHO. There is also a belief in some cases that women's genitalia are unfeminine, ugly or unclean. Apart from the pain and distress involved in the procedure at the time, there can be long-term health consequences, even sometimes involving infertility. Bladder and urinary tract infections and cysts are not uncommon. There is an increased risk of problems during childbirth, which could in extreme cases lead to the death of the baby. Where FGM involves sewing up or narrowing the vaginal opening, this must be undone to allow sexual intercourse and then before the woman can give birth.

Ovarian Cancer: 10 Warning Signs Of ‘The Silent Killer’ Women Should Never, Ever Ignore

Each year, more than 20,000 women are diagnosed with ovarian cancer. As the fifth most common cancer among women, ovarian cancer is commonly nicknamed the “silent killer” among women over the age of 55. Though by no means linked uniquely to postmenopausal women, ovarian cancer is highly aggressive, and, according to doctors, incredibly difficult to detect. Mother Erin Barret only happened to discover she had ovarian cancer because she was pregnant. We are well-versed in the cancer symptoms that absolutely cannot be ignored (as we hope you are, too) — but when looking at gynecological cancers, many of these universal cancer symptoms may sound quite general and vague. Nevertheless, we’ll learn more about the 10 most common symptoms that women may experience, in an exclusive look below. These symptoms can occur during both the earliest and more advanced stages of detection, and can range from intense abdominal and pelvic pains, to irregular menstrual cycles and even excessive hair growth. Scroll down to go through the list, and please make sure to consult your doctor if you are experiencing severe forms of any of the following symptoms. 1. Frequent Back Pain There can be many causes for back pain. But if you know for certain that you are not suffering from any physical ailments and discomforts — like ligament strain, osteoporosis, arthritis, or skeletal irregularities — then it’s best to get checked out by your doctor. Although it’s a symptom that’s common in women who don’t have ovarian cancer, back pain can be cause for concern, according to MedlinePlus. Look out for back pain that worsens over time for unknown reasons. 2. Pain In Lower Abdomen Or Pelvic Region If you are experiencing pain in the lower abdominal region, or if you feel a heaviness in your pelvic region on a daily basis, you should check with your doctor to understand the causes of these symptoms. One commenter on health website eMedicineHealth says: “I suddenly felt bloating in my abdomen and felt like something moving around. My mistook it for gas and treated me for gastritis. I developed a sharp pain near my diaphragm.” She then visited a gynecologist, who, after conducting an ultrasound, detected ovarian cancer. 3. Very Abnormal Menstrual Cycles Statistically, more women over the age of 55 are diagnosed with ovarian cancer. However, you don’t need to be post-menopausal in order to develop ovarian cancer. According to Healthline, gynecological cancers can occur in younger women, too — even in those who haven’t had their first periods yet. If you are experiencing abnormal vaginal bleeding, or a drastic change in your menstrual cycle, it’s best to let your doctor know so that further tests can be done. 4. Excessive Fatigue Along with breathlessness, nausea, and an increased loss of appetite, extreme fatigue is one of the symptoms that a patient at a progressed stage of ovarian cancer may see. More than 80% of women do experience at least one symptom of ovarian cancer a few months before getting diagnosed, according to Medical News Today. That’s why it’s so important to study your own body. Don’t wait for more than three months after experiencing an odd symptom to get checked out, like 17% of women do. 5. If You Feel Full Easily “Early satiety,” or feeling full too quickly when you eat, is one of the four most noticeable and common symptoms of ovarian cancer, according to Healthline. It could be easy to mistake this symptom as a digestive order — but unlike illnesses caused by the digestive track, ovarian cancer will see a worsening of symptoms, says Medical News Today. 6. Painful Sex Pain during intercourse may be another strong indicator that you are in an earlier stage of ovarian cancer, according to Medical News Today. This is linked to pain and pressure in the pelvic region, and the need to urinate more urgently and frequently. No matter what painful sex may indicate, it’s best to alert your doctor to the symptom as fast as you can. 7. Nausea And Vomiting Nausea and vomiting, like all the other symptoms listed in this guide, can indicate a variety of problems. It frequently goes hand-in-hand with other symptoms, like constipation, diarrhea, and bloating, according to WebMD. According to gynecologist Jeffrey L. Stern, M.D., advanced cases of ovarian cancer can often result in the blockage of the intestines, causing severe nausea, abdominal pain, and weight loss. 8. Bloating Belly Bloating is one of the most noted warning signs of ovarian cancer, along with general abdominal pain. Famously, cancer patient Wendie Webb had a bloated stomach so large that it looked like she was pregnant. In the end, doctors removed her 13-pound tumor and eventually declared her cancer-free. If bloating persists for days, or even weeks, consult your doctor. Don’t risk confusing it as a symptom of irritable bowel syndrome! 9. Dark And Coarse Hair Growth Some women have reportedly experienced excessive hair growth as a symptom. While not typically topping the list of cancer symptoms, it is definitely something that is cause for concern. However, according to Women’s Health, some women experience the exact opposite — hair loss. 10. Frequent Constipation The abdominal region and the digestive track are the regions most affect by the cancer, especially in its earliest stages. In addition to general pain in the stomach area, other related symptoms may include digestive issues, loss of appetite, and increased gas, according to MedlinePlus. Are you going to be checking your body for irregularities from now on?

Ovarian Cancer: 10 Warning Signs Of ‘The Silent Killer’ Women Should Never, Ever Ignore

Each year, more than 20,000 women are diagnosed with ovarian cancer. As the fifth most common cancer among women, ovarian cancer is commonly nicknamed the “silent killer” among women over the age of 55. Though by no means linked uniquely to postmenopausal women, ovarian cancer is highly aggressive, and, according to doctors, incredibly difficult to detect. Mother Erin Barret only happened to discover she had ovarian cancer because she was pregnant. We are well-versed in the cancer symptoms that absolutely cannot be ignored (as we hope you are, too) — but when looking at gynecological cancers, many of these universal cancer symptoms may sound quite general and vague. Nevertheless, we’ll learn more about the 10 most common symptoms that women may experience, in an exclusive look below. These symptoms can occur during both the earliest and more advanced stages of detection, and can range from intense abdominal and pelvic pains, to irregular menstrual cycles and even excessive hair growth. Scroll down to go through the list, and please make sure to consult your doctor if you are experiencing severe forms of any of the following symptoms. 1. Frequent Back Pain There can be many causes for back pain. But if you know for certain that you are not suffering from any physical ailments and discomforts — like ligament strain, osteoporosis, arthritis, or skeletal irregularities — then it’s best to get checked out by your doctor. Although it’s a symptom that’s common in women who don’t have ovarian cancer, back pain can be cause for concern, according to MedlinePlus. Look out for back pain that worsens over time for unknown reasons. 2. Pain In Lower Abdomen Or Pelvic Region If you are experiencing pain in the lower abdominal region, or if you feel a heaviness in your pelvic region on a daily basis, you should check with your doctor to understand the causes of these symptoms. One commenter on health website eMedicineHealth says: “I suddenly felt bloating in my abdomen and felt like something moving around. My mistook it for gas and treated me for gastritis. I developed a sharp pain near my diaphragm.” She then visited a gynecologist, who, after conducting an ultrasound, detected ovarian cancer. 3. Very Abnormal Menstrual Cycles Statistically, more women over the age of 55 are diagnosed with ovarian cancer. However, you don’t need to be post-menopausal in order to develop ovarian cancer. According to Healthline, gynecological cancers can occur in younger women, too — even in those who haven’t had their first periods yet. If you are experiencing abnormal vaginal bleeding, or a drastic change in your menstrual cycle, it’s best to let your doctor know so that further tests can be done. 4. Excessive Fatigue Along with breathlessness, nausea, and an increased loss of appetite, extreme fatigue is one of the symptoms that a patient at a progressed stage of ovarian cancer may see. More than 80% of women do experience at least one symptom of ovarian cancer a few months before getting diagnosed, according to Medical News Today. That’s why it’s so important to study your own body. Don’t wait for more than three months after experiencing an odd symptom to get checked out, like 17% of women do. 5. If You Feel Full Easily “Early satiety,” or feeling full too quickly when you eat, is one of the four most noticeable and common symptoms of ovarian cancer, according to Healthline. It could be easy to mistake this symptom as a digestive order — but unlike illnesses caused by the digestive track, ovarian cancer will see a worsening of symptoms, says Medical News Today. 6. Painful Sex Pain during intercourse may be another strong indicator that you are in an earlier stage of ovarian cancer, according to Medical News Today. This is linked to pain and pressure in the pelvic region, and the need to urinate more urgently and frequently. No matter what painful sex may indicate, it’s best to alert your doctor to the symptom as fast as you can. 7. Nausea And Vomiting Nausea and vomiting, like all the other symptoms listed in this guide, can indicate a variety of problems. It frequently goes hand-in-hand with other symptoms, like constipation, diarrhea, and bloating, according to WebMD. According to gynecologist Jeffrey L. Stern, M.D., advanced cases of ovarian cancer can often result in the blockage of the intestines, causing severe nausea, abdominal pain, and weight loss. 8. Bloating Belly Bloating is one of the most noted warning signs of ovarian cancer, along with general abdominal pain. Famously, cancer patient Wendie Webb had a bloated stomach so large that it looked like she was pregnant. In the end, doctors removed her 13-pound tumor and eventually declared her cancer-free. If bloating persists for days, or even weeks, consult your doctor. Don’t risk confusing it as a symptom of irritable bowel syndrome! 9. Dark And Coarse Hair Growth Some women have reportedly experienced excessive hair growth as a symptom. While not typically topping the list of cancer symptoms, it is definitely something that is cause for concern. However, according to Women’s Health, some women experience the exact opposite — hair loss. 10. Frequent Constipation The abdominal region and the digestive track are the regions most affect by the cancer, especially in its earliest stages. In addition to general pain in the stomach area, other related symptoms may include digestive issues, loss of appetite, and increased gas, according to MedlinePlus. Are you going to be checking your body for irregularities from now on?

Professional and Linguistic Assessment Board test

The Professional and Linguistic Assessment Board test (PLAB) is the assessment procedure conducted by the General Medical Council of the United Kingdom that is required for overseas doctors outside the European Union before they can practice medicine in the UK. The PLAB test has 2 parts: Has EMQs (extended matching questions) and SBAs (Single Best Answer questions), This part is conducted in a number of countries including Egypt (Cairo), India, Pakistan, Nigeria, Sri Lanka, Bangladesh. Part 2 : Consists of an objective structured clinical examination (OSCE). This Part is available only in United Kingdom. It consists of 14 clinical stations, a pilot station and a rest station. The pilot station is usually unannounced and mixed with the clinical stations. The marks for the pilot station do not count towards the final score. All the stations are of five minutes duration. The level of difficulty of the clinical part of the PLAB exam is set at the level of competence of a senior house officer (SHO) in a first appointment in a UK hospital. The skills assessed in this exam are: clinical examination, practical skills, communication skills, and history taking.

FDA Pregnancy Categories FDA Pregnancy Risk Information

In 2015 the FDA replaced the former pregnancy risk letter categories on prescription and biological drug labeling with new information to make them more meaningful to both patients and healthcare providers. The FDA received comments that the old five-letter system left patients and providers ill-informed and resulted in false assumptions about the actual meaning of the letters. The new labeling system allows better patient-specific counseling and informed decision making for pregnant women seeking medication therapies. While the new labeling improves the old format, it still does not provide a definitive “yes” or “no” answer in most cases. Clinical interpretation is still required on a case-by-case basis. The Pregnancy and Lactation Labeling Final Rule (PLLR) went into effect on June 30, 2015; however, the timelines for implementing this new information on drug labels (also known as the package insert) is variable. Prescription drugs submitted for FDA approval after June 30, 2015 will use the new format immediately, while labeling for prescription drugs approved on or after June 30, 2001 will be phased in gradually. Medications approved prior to June 29, 2001 are not subject to the PLLR rule; however, the pregnancy letter category must be removed by June 29, 2018. For generic drugs, if the labeling of a reference listed drug is updated as a result of the final rule, the abbreviated new drug application (ANDA) labeling must also be revised. Labeling for over-the-counter (OTC) medicines will not change, as OTC drug products are not affected by the new FDA pregnancy labeling. The A, B, C, D and X risk categories, in use since 1979, are now replaced with narrative sections and subsections to include: Pregnancy (includes Labor and Delivery): Pregnancy Exposure Registry Risk Summary Clinical Considerations Data Lactation (includes Nursing Mothers) Risk Summary Clinical Considerations Data Females and Males of Reproductive Potential Pregnancy Testing Contraception Infertility The Pregnancy subsection will provide information about dosing and potential risks to the developing fetus and registry information that collects and maintains data on how pregnant women are affected when they use the drug or biological product. Information in drug labeling about the existence of any pregnancy registries has been previously recommended but not required until now. Contact information for the registries will also be included, and pregnant women are encouraged to enroll to help provide data on the effects of drug use or biologics in pregnancy. If information for the subsections of Pregnancy Exposure Registry, Clinical Considerations, and Data is not available, these subsections will be excluded. The Risk Summary subheadings are always required, even if no data is available. The Lactation subsection will replace the “Nursing Mothers” subsection of the old label. Information will include drugs that should not be used during breastfeeding, known human or animal data regarding active metabolites in milk, as well as clinical effects on the infant. Other information may include pharmacokinetic data like metabolism or excretion, a risk and benefit section, as well as timing of breastfeeding to minimize infant exposure. In the subsection entitled Females and Males of Reproductive Potential, relevant information on pregnancy testing or birth control before, during or after drug therapy, and a medication’s effect on fertility or pregnancy loss will be provided when available. Why Did the FDA Make This Change? Clinically, many women require drug treatment during pregnancy due to chronic conditions such as epilepsy, diabetes, hypertension (high blood pressure), or asthma. To withhold drug treatment would be dangerous for both mother and baby. In addition, women are having babies at a later age, which can boost the number of women with chronic conditions. Accessible and understandable pregnancy and lactation information is important for women and their health care provider’s to assess risk versus benefit. The FDA has received requests to improve the decades-old content and format of pregnancy prescription drug labeling since 1992. According to the Drug Information Division at the FDA, they obtained input from many affected groups and held public hearings, advisory committee meetings, and focus groups to assess the changes. In 2008, the FDA issued the proposed rule and then opened a docket for public comments. Clinicians and patients were often confused by the meaning of the pregnancy risk categories because, according to the FDA, it was overly simplistic, led to misinformation, and did not adequately address the available information. Examples of drugs approved since June 30th, 2015 showing various new pregnancy and lactation subsections in their labels: Addyi (flibanserin) - indicated for generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Descovy (emtricitabine and tenofovir alafenamide fumarate) - indicated for HIV-1 infection. Entresto (sacubitril and valsartan) - indicated for heart failure. Harvoni (ledipasvir and sofosbuvir) - indicated for chronic viral hepatitis C infection (HCV). Praluent (alirocumab) - indicated for heterozygous familial hypercholesterolemia, or patients with atherosclerotic heart disease who require additional lowering of LDL-cholesterol. FDA Pregnancy Risk Categories Prior to 2015 In 1979, the FDA established five letter risk categories - A, B, C, D or X - to indicate the potential of a drug to cause birth defects if used during pregnancy. The categories were determined by assessing the reliability of documentation and the risk to benefit ratio. These categories did not take into account any risks from pharmaceutical agents or their metabolites in breast milk. In the drug product label, this information was found in the section “Use in Specific Populations”. The former pregnancy categories, which still may be found in some package inserts, were as follows: Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Example drugs or substances: levothyroxine, folic acid, liothyronine Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Example drugs: metformin, hydrochlorothiazide, cyclobenzaprine, amoxicillin, pantoprazole Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Example drugs: tramadol, gabapentin, amlodipine, trazodone Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Example drugs: lisinopril, alprazolam, losartan, clonazepam, lorazepam Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Example drugs: atorvastatin, simvastatin, warfarin, methotrexate, finasteride

Quick And Accurate Way Of Diagnosing Endometriosis (Not By Laparoscopy)

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe's leading reproductive medicine journal Human Reproduction. Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated. Now researchers at the University of Sydney and Mu'tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy. Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman's pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis. In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis/ In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu'tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition. The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis. Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2. The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group. Dr Al-Jefout said: "This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility." Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: "It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres." He continued: "Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated." In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. "The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility." The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. "Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist," he concluded. In the second study, led by Professor Thomas D'Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A∂, adrenergic and cholinergic nerve fibres). Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: "We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis." Prof D'Hooghe said: "Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity." Dr Bokor and the team of Prof D'Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. "If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed," said Prof D'Hooghe.

Daily Low-Dose Aspirin Can Boost Chances of Successful Pregnancy

For some women who are trying to get pregnant, taking a low dose of aspirin daily may boost their chances of having a baby, according to a new analysis. The analysis, which looked at women who'd had a prior pregnancy loss and taken part in an earlier study, found that women who benefited from the aspirin regimen had high blood levels of C-reactive protein (CRP), a marker of inflammation in the body. Among these women, those who took a daily aspirin were 31 percent more likely to become pregnant, and 35 percent more likely to carry a pregnancy to term, than those who took a placebo. However, it's too soon to officially recommend daily aspirin to prevent pregnancy loss, the researchers said. Prior to this report, researchers knew that inflammation in the body could contribute to reproductive problems. For example, women with pelvic inflammatory disease or polycystic ovary syndrome — two conditions that involve inflammation — are at increased risk for infertility. But few studies have examined whether lowering levels of inflammation in a woman's body would affect her chances of successfully becoming pregnant and giving birth. In the new analysis, the researchers analyzed information from more than 1,200 U.S. women ages 18 to 40 who had previously experienced a miscarriage or stillbirth. The women were randomly assigned to take either a low dose of daily aspirin (81 milligrams) — which is thought to counteract inflammation — or a placebo, for six menstrual cycles while they were trying to become pregnant. If the women became pregnant, they continued taking the pills until 36 weeks of pregnancy. (A full-term pregnancy is 39 to 40 weeks.) Then, the researchers divided the women into three groups: those with low, medium and high CRP levels. Overall, 55 percent of the women in the study became pregnant and gave birth. Among the women with high CRP levels, those who took a daily aspirin had a birth rate of 59 percent, compared with just 44 percent among those who took the placebo. Taking daily aspirin also lowered CRP levels in the women with the highest CRP levels. Women with low or medium CRP levels had about the same birth rate, regardless of whether they took aspirin or a placebo, the researchers found. In an earlier analysis of this same study, published in 2014, researchers did not find a link between taking aspirin and a reduced risk of pregnancy loss. But for that analysis, the researchers did not look at the level of inflammation in the women's bodies. The new findings suggest that "inflammation may significantly harm women's ability to become pregnant," and that taking aspirin prior to conception may reduce this risk, the researchers said. In the future, doctors might consider using a screening test for CRP levels to determine whether a woman may benefit from aspirin treatment before and during pregnancy, the researchers said. However, future studies would be needed to examine this, and to determine exactly what the cutoff would be for "high" CRP levels, they said. Taking high doses of aspirin (more than 100 milligrams a day) during pregnancy may increase the risk of pregnancy loss, congenital defects and complications with the fetuses' heart, according to the Mayo Clinic. Women should speak with their doctor about taking pain medication during pregnancy. The anaysis, conducted by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, was published online Feb. 3 in the Journal of Clinical Endocrinology and Metabolism.

Hysterectomy Tied To Early Death If Ovaries Are Removed

Scientists say removing ovaries during a hysterectomy could increase a woman’s risk for heart disease, cancer, and premature death. A 10-year study, the largest of its kind, compared women who were treated for a benign disease who had both ovaries removed with those who had one or none removed. Researchers looked at 113,679 cases of women aged 35-45 from April 2004 to March 2014. A third of the patients studied had both ovaries removed. “…The removal of a metabolically active organ such as the ovary may have harmful effects in the long term.” Women who had one or no ovaries removed were less likely to develop ischemic heart disease (coronary artery disease) or cancer after hysterectomy than those who had both (bilateral) ovaries removed. Further, fewer women who kept one or both ovaries compared to those who had both removed died within the duration of the study—0.6 percent compared to 1.01 percent. Although removal of both ovaries protects against subsequent development of ovarian cancer, researchers believe premenopausal women should be advised that this benefit comes at the cost of an increased risk of cardiovascular disease and of other more prevalent cancers and higher overall mortality. “The combination of biological plausibility and the massive ‘effect size’ make a compelling case that women can be advised that their risk of ovarian cancer is greatly reduced by surgical removal of both ovaries,” says Richard Lilford, professor of obstetrics and gynecology at the University of Warwick Medical School. “However, the lifetime risk of developing ovarian cancer is one in 52 in the UK, and the removal of a metabolically active organ such as the ovary may have harmful effects in the longterm. “If so, these long-term disadvantages (combined with the unpleasant shorter term effects of acute estrogen deprivation) must be offset against the benefit conferred by protection from ovarian cancer.” The researchers used a national database of hospital admissions which they linked to the national register of deaths. Unlike a previous, smaller Nurses’ Health Study, the new research was conducted on a countrywide basis rather than in a sample, and examined associations between operation type and subsequent hospital admissions, as well as mortality. Forty percent of women with no specific risk factors for reproductive cancer had their ovaries removed during abdominal hysterectomy in the 35-45 age group. “This might be a higher proportion than would be expected among women who were fully aware of the worse health outcomes with bilateral removal that we’ve reported,” Lilford says. “In that case, we might expect the proportion of women who select bilateral ovarian removal to decline as the health risks that must be traded for a reduced incidence of ovarian cancer come into sharper focus.” The study also pointed to a small decline in the number of hysterectomies performed. Nearly 9,000 women had a hysterectomy for a benign condition in the target age range in 2014, compared to almost 13,000 in 2004-05. The researchers acknowledge the data available wasn’t as detailed as they would have liked, in particular there was no information on the use of hormone replacement therapy—but they plan to re-examine the data at a later date to examine trends over the long term.

Is It Normal to Have Irregular Periods After Birth?

Do you wonder what causes irregular periods after delivery or when they will get back to normal? Many women who were recently pregnant have the same question in their minds. Once a woman becomes pregnant, her period stops due to hormonal changes. After delivery, the periods will return. However, periods after childbirth usually don’t come with the same regularity as before, they may also become heavier or lighter. Is It Normal to Have Irregular Periods After Birth? First you can get a relief by knowing that this problem is normal and should not cause alarm. The period usually gets back to normal after a few cycles, although some women experience these changes for much longer. However, sudden changes such as heavy bleeding or clots weeks after childbirth could mean that the placenta was not expelled in full. They can also be the symptoms of an infection in the uterus. In case of bleeding or clots that soak one pad within one hour, you need to visit your doctor or gynecologist for examination. What Causes Irregular Periods? The hormonal changes that arise after childbirth are the main reason for this. Prolactin hormone is secreted by the pituitary gland to trigger secretion of breast milk. It suppresses ovulation and estrogen hormone. This leads to irregular periods and in some cases causes absence of menstruation when breastfeeding. Tips for Dealing with Irregular Periods Take a balanced diet, drink a lot of water and exercise regularly. Include whole grain, fruits and vegetables in your diet. The balanced diet and exercise will help your body’s hormone levels to stabilize, regularizing the irregular periods after birth. Once you become sexually active following childbirth, avoid the pill or other hormonal contraceptives because these will further interfere with your unstable hormonal state. But be sure to use condom. While breastfeeding may delay menstruation and ovulation, it is not a foolproof contraception method. In some cases, ovulation occurs even with absence of menstruation. Sex in such circumstances can lead to an unplanned pregnancy. Common Changes in Menstruation After Childbirth Following are the most common temporary changes in menstruation after delivery: Menses may resume as light bleeding or spotting. This is most common for partially breastfeeding women who also bottle feed the baby. Menses may resume with heavy bleeding. Visit your gynecologist if this continues beyond the first few cycles after childbirth. You may have longer or shorter cycles besides irregular periods after birth. You may experience dysmenorrhea (painful periods). You may get PMS (premenstrual syndrome) which presents with nausea, dizziness, fluid retention, edema and moodiness before the periods. Other Mothers' Experiences “I think it’s normal. I’m having the same issues. I got my son in October, and breastfed him for about 7 weeks. 2 months later, I had my first period which lasted 2 weeks. The next period came after 5 weeks, and I had my third after another 8 weeks. The second and third lasted 1 week each. 2 months later, I’m still waiting for my fourth periods. I can't be pregnant because I haven’t had unprotected sex.” “Same here. I was expecting my third periods over 10 days ago, but they’ve not come. I decided to see the doctor but she assured me I am not pregnant. She told me this could be happening because of breastfeeding. My son is 6 months and is growing strong. The doctor suggested I take a pill called Orgamed to induce periods. She said it has no ill effect on us but I will wait a little longer and perhaps take it later. I suggest you wait a few days or a week; then see your doctor for meds to regulate your periods. But don’t worry. Delayed and irregular periods after birth seem to be normal.” When Should Your Period Return After Birth? For some women, the issue is not irregular periods; it’s the absence of periods for months. There are two factors that determine resumption of periods: Exclusive breastfeeding or not Individual hormonal state Return of Periods for Mothers Practicing Exclusive Breastfeeding For women providing exclusive breastfeeding for their babies, periods may resume six months after delivery. This is the time when the baby starts supplemental feeding. However, some women don’t get their periods for up to one or even two years after childbirth. A few women only resume their menses once they stop breastfeeding. Return of Periods for Breastfeeding Mothers Also Giving Supplemental Feeds For women who combine breastfeeding with bottle feeding, periods normally return within 4 to 10 weeks after childbirth. Return of Periods for Women Who Are Not Breastfeeding For women who don’t breastfeed their babies entirely, periods can return a month after childbirth. However, it is more typical for them to get the first period by the third month after delivery. Every individual is unique. Irrespective of whether you breastfeed exclusively or not at all, your individual hormonal makeup will determine when your periods resume. It is not abnormal for an exclusively breastfeeding woman to start getting her period one month after giving birth.