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‘The higher the metabolic risk is, the higher the risk is to catch Covid-19’

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Here is what women need to know

May 23, 2021 3:06 PM

CNN

Posted: May 23, 2021 3:06 PM

Originally Published: 23 MAY 21 06:02 ET

Updated: 23 MAY 21 15:34 ET

By Alessandria Masi, CNN

(CNN) — Last July, when her immediate family tested positive for Covid-19, Breanna Aguilar did not fit into any groups considered at higher risk for severe disease.

She is 31 years old, a pet sitter and former fitness teacher who once ran a half marathon. She was, by most measures, healthy.

When Aguilar got Covid-19 she lost her sense of taste, had mild fevers and muscle weakness. She could barely keep anything down yet gained about 30 pounds. Later, she developed pelvic pain, cystic acne, breast tenderness, headaches, brain fog and extreme fatigue.

It has been months since then, but she says the low energy, chronic pain and brain fog — long-haul Covid-19 symptoms — remain and she can’t even go for a 15-minute walk without needing a break. She’s also now dealing with insulin resistance and taking several medications to keep that and her hormone levels under some control. Her doctor told her she’ll likely be dealing with this fallout of Covid-19 for the rest of her life.

More than a year into the pandemic, one study has found that some women are at higher risk for Covid-19 compared to others in their age and sex groups. These women, often young and otherwise healthy like Aguilar, have an underlying condition that isn’t mentioned on any Covid-19 comorbidity list: polycystic ovary syndrome, or PCOS.

PCOS, which affect about 1 in 10 women of “childbearing age,” is an imbalance of reproductive hormones that can lead to irregular menstrual cycles, high androgen levels and ovarian cysts. But it can also come with a host of other health problems, nearly all of which overlap Covid-19 comorbidities.

“PCOS is completely underestimated in its impact. It’s sort of seen as some reproductive issue that is not clinically relevant. But this is completely wrong … Patients need to be seen as a high-risk population,” said Dr. Wiebke Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham in the United Kingdom.

More than half of people with PCOS develop diabetes before their 40th birthdays, and up to 80% are overweight. They have higher risk of insulin resistance, heart disease and endometrial cancer, a cancer that begins in the uterus. Many have high blood pressure and low levels of vitamin D. These complications of PCOS have also been associated with a potentially higher risk for severe Covid-19.

Despite how common PCOS is, as well as the serious complications it can come with, health experts say the condition has long been overlooked, misunderstood and under-researched, leaving patients to advocate for themselves or even educate practitioners to get treatment. And with very little research looking at whether women with PCOS are at higher risk for more severe Covid-19 or long-term symptoms, some fear the same is happening with public health policy around the pandemic.

“My advice would be to include women with PCOS as … potentially a high-risk group,” said Dr. Katherine Sherif, chief of Women’s Health at Jefferson University’s Department of Medicine and a leading PCOS expert. But she warned: “We’re working in a very large system that is full of silos. Nobody’s going to jump up and say, ‘Oh, well, don’t forget about PCOS.’”

“If Anthony Fauci said, ‘you need to look at the high-risk groups like PCOS,’ people might pay more attention,” she said.

Part of the reason PCOS flies under the radar in general and with regards to Covid-19, according to Arlt and Sherif, is because it is often dismissed as a women’s health issue — an obstacle of the ovary. Over the past year, we’ve learned about numerous preexisting health conditions that put a person at higher risk for severe Covid-19 illness, but PCOS isn’t one of them.

For Arlt, who co-authored the first major study published in February in the European Journal of Endocrinology, the name PCOS is a misnomer. It is not a disorder of the ovary, Arlt said, but a “lifelong metabolic disease” and should be treated as such when assessing Covid-19 vulnerability.

“The higher the metabolic risk is, the higher the risk is to catch Covid-19,” Arlt said. “People looked at obesity and Type 2 diabetes and hypertension and heart disease, but they have not looked at PCOS systematically before we did. Because they just don’t consider this a metabolic risk factor. That’s something that we would like to change.”

‘Something in PCOS is actually driving this’

Arlt and researchers at the University of Birmingham in the United Kingdom found that women with PCOS had a 51 percent higher chance of confirmed or suspected Covid-19 infection than women without. Using primary care records from January to June 2020, they identified more than 21,000 PCOS patients and a control group of more than 78,000 without, matched for age and location.

Researchers then “wanted to understand if the increased incidence of Covid-19 was only because of PCOS, or was it also because of the underlying risk factors that women with PCOS have?” lead author Anuradhaa Subramanian told CNN. In other words, if a woman has PCOS and Type 2 Diabetes, which one is putting her at increased risk for Covid-19?

In a fully adjusted model that took various risk factors into account, women with PCOS still had a 28% increased risk for confirmed or suspected Covid-19 infection, according to the study.

Subramanian says the results didn’t surprise her. However, “it gave us more confidence… that it’s not just about the risk factors associated with PCOS, but something in PCOS is actually driving this,” she said.

But because the data was pulled from primary healthcare databases, researchers couldn’t look at whether patients with PCOS had more severe or long-term Covid-19 symptoms. What’s more, PCOS is not a one-size-fits-all disorder and Covid-19 may or may not have a different impact or risk level depending on the person. There are many questions we don’t have definitive answers to yet, says Dr. Anuja Dokras, director of the Polycystic Ovary Syndrome Center at Penn Medicine.

“We need to get this information now that (Covid-19 has) lasted a full year,” said Dokras. “It’s affecting so many people that it would be good to look back at this literature and just sort it out because these are confounding factors.”

Searching for answers

So far, whether people with PCOS have more severe complications from Covid-19 is anecdotal, leaving some women with only speculation about how Covid-19 affects PCOS.

In Aguilar’s case, she was diagnosed with PCOS after she was exposed to Covid-19, despite likely having it for years but not recognizing the symptoms. “I had some of these underlying symptoms, my body was able to just manage them to a point for most of my life, and then contracting Covid really just wiped out all of my body’s defenses and ability to regulate anything,” she said her doctor told her.

But she still doesn’t know why or whether her symptoms will ever improve.

Kris Nealon has also spent much of the past year looking for answers.

She was diagnosed with PCOS at age 12, and the disorder has left her struggling with her weight and insulin resistance. These factors, she says, made her concerned that she could have severe Covid-19 symptoms and maybe even require hospitalization. So last summer she did what most have done during the pandemic: She Googled it. She recalled searching “‘should I be concerned…insulin resistance COVID?’ or ‘PCOS COVID?’”

Nealon didn’t find answers. She got Covid-19 in October and says her symptoms were mild. But when that turned into muscle and joint pain, extreme fatigue, depression, insomnia and brain fog, she did what was recommended: Talk to her doctor.

In Nealon’s case, she spoke to several. Having lived with PCOS more than half her life, she was aware of the complications and wanted to know how this could impact her long-term Covid-19 symptoms.

She says the primary doctor for her long-term symptoms said her only Covid-19 comorbidity was her weight.

“He’s been nice and understanding but … you can see him be like, ‘Lady problems, don’t worry about it. This is your lungs,’” she said. She told him that PCOS is linked to anxiety and depression and asked if that could be related to Covid-19 fatigue and insomnia. She also asked about her heart, explaining that PCOS and Covid-19 can cause complications.

But aside from suggesting that losing weight might help, Nealon recalled her doctor saying “it had nothing to do with PCOS. He’s like, ‘no, that’s your ovaries and stuff.’”

After Covid-19, Nealon also noticed her PCOS symptoms “went crazy.” She says she had extreme pain in her lower abdomen. An ultrasound showed her fallopian tubes “suddenly looked very concerning” and she had an ovarian cyst burst.

She went to her gynecologist, the doctor who first diagnosed her with PCOS, and asked, “Does this have anything to do with (that) I just had Covid?”

She says her doctor told her: “No, there’s no literature about that.”

And there wasn’t. Weeks after Nealon tested positive, Allison Roach and Chitra Gotluru, two medical students at Florida International University, finished their journal article exploring the potentially higher risk women with PCOS have for Covid-19-related morbidity. No data set of patients with both diagnoses existed, they said.

Risk ‘obvious but not proven’

Roach’s and Gotluru’s research, published in the March issue of the journal Obstetrics and Gynecology, shows the potentially higher risk for PCOS patients comes down to “comorbidities, androgens and lipotoxicity.”

People with PCOS often have higher levels of and sensitivity to androgens, male sex hormones. This could “potentially directly affect the susceptibility to COVID-19,” Roach and Gotluru wrote. Androgens work as a “gateway,” in very simple terms, to let in Covid-19, Roach says.

What’s more, it is common for people with PCOS to have chronic inflammation — an immune system that is in a near-constant state of fighting off harm. Impaired insulin regulation and obesity can lead to a toxic buildup of fatty acid in tissue, known as lipotoxicity, potentially damaging organs.

This can also trigger the secretion of immune-signaling cells called cytokines. While cytokines are a vital part of the body’s immune response, too much can cause what’s known as a cytokine storm. Adding a Covid-19 infection to that can cause further cytokine secretion, potentially triggering one of these storms and causing the immune system to attack the body’s cells, not just the pathogen. And there is research that suggests this can occur “whether you are overweight or not,” Gotluru told CNN.

For Jefferson University’s Sherif, the risk of more severe Covid-19 symptoms for PCOS patients is “obvious but not proven.” Obvious because “If testosterone increases inflammation, and if … men who are in the hospital with Covid complications and have high testosterone levels, it makes sense that it would put women with PCOS more at risk.”

This is not proven, she says, because so little research exists.

Drawing from her own research about PCOS and heart disease, Sherif said, “What’s important for people to understand is that this is independent of obesity.”

“It’s the high insulin and high testosterone that confer their risk for a greater risk for Covid compared to weight matched controls,” she said. “So, you have two women who are 100 kilograms. The one with PCOS is more likely to become diabetic or have sleep apnea, or to be sick from Covid.”

Without that data, some doctors and researchers say this is something patients with PCOS should be aware of, but not to panic. If you do get Covid-19, it’s important to tell your doctor you have PCOS and any medications you’re taking, Gotluru says.

“Let your provider know … that there is research out there that is worrisome about PCOS and you’d like to be careful,” she said.

In the meantime, women like Aguilar and Nealon are still searching for answers. Nealon says her doctors still haven’t made a connection between the fallout of Covid-19 and her PCOS. She isn’t surprised.

“That’s what it’s like, just with PCOS, let alone adding Covid in,” Nealon said. “You go to a doctor with a list of symptoms, and you either get ‘you’re fat’ or ‘you’re overthinking things.’”

Aguilar says that constantly having to educate people in her life has been exhausting on top of her two new diagnoses.

“A lot of people like to talk about the survival rate is so high and the death rate is so low, but what they’re not taking into account is the degree that lives are changing because of illnesses that are popping up from this, or just the long-haul symptoms that are so debilitating,” Aguilar said. “It’s hard to overcome.”

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Women’s Health

Crews break ground on women’s health center at Providence St. Joseph campus – Orange County Register

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A four-story, 137,000 square meter health center for women and babies has laid the foundation stone on the campus of Providence St. Joseph Hospital in Orange.

  • Officials break the ground for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility provides access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Rendering of the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif., Tuesday, September 21, 2021. The four-story, 137,000-square-foot facility provides access to health services, benefits and resources for Orange County residents. It is currently scheduled to open in autumn 2023. (Courtesy Providence St. Joseph Hospital)

  • Sister Judith Dugan bows her head as the Reverend Kevin Vann blesses the groundbreaking ceremony for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide Orange County’s residents with access to health services, benefits and resources. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Reverend Kevin Vann prepares to help officials break ground at the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Philanthropist Marsh Moeller speaks about her mother Helen Caloggero during a cornerstone ceremony for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 137,000-square-foot facility will be Provide Orange County’s residents with access to health services, benefits and resources. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Officials break the ground for the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, California on Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility provides access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

  • Reverend Kevin Vann prepares to help officials break ground at the Helen Caloggero Women’s and Family Center at Providence St. Joseph Hospital in Orange, Calif. On Tuesday, September 21, 2021. The four-story, 150,000-square-foot facility will provide access to health services, benefits and resources for Orange County’s residents. It is currently scheduled to open in autumn 2023. (Photo by Jeff Gritchen, Orange County Register / SCNG)

The crews began work on the new facility on Tuesday, which will occupy a space on the corner of Main Street and Stewart Drive. Orange Mayor Mark Murphy, Orange County Supervisor Donald Wagner and Bishop of Orange Rev. Kevin Vann showed their support for the new development at a ceremony on site.

The Helen Caloggero Women and Family Center – named after the mother of a major donor to the project – will streamline services to women and families, hospital officials said, bringing “mother-and-baby services currently available in nine different locations across the hospital.” one “. central location.”

The center offers a variety of women’s health resources, including pelvic health and rehabilitation services, exams for mothers and their babies, mental health services, and a pharmacy.

Part of the facility will also become a new natural birthing center “where women will receive the individual care midwives provide in a home setting,” according to a press release. Food, retail and office space are among other features of the future location.

“We are excited to offer our patients this wide range of services in a beautiful, new and convenient location as it will truly make it easier for them to access our world-class caregivers and the latest innovative technology in one place,” said Michelle Genova , Chief Nursing Officer at Providence St. Joseph Hospital, in the news release.

The center is scheduled to open in 2023. The St. Joseph Hospital Foundation is still raising $ 2.3 million for the new facility.

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Women’s Health

‘Bachelor In Paradise Couples’ Who End Up Together, Per A Matchmaker

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Lots of adorable couples have come and gone this season of Bachelor in Paradise – but which ones are staying here? From Reality Steve’s post-show spoilers to the fans’ incredible super detective skills, there are some popular theories.

But most of these guesses are missing a key factor: chemistry. After all, a couple is only as good as their food-related innuendos (if you look at you, Kenny and Mari).

Amber Kelleher-Andrews is the co-founder and CEO of Kelleher International, one of the largest matchmaking companies in the US, seemed doomed from the start.

Ready to Hear the Cold Hard Truth About Your Favorites? Amber spills it all below:

What’s so different about dating on TV?

“The hard thing about TV is that it’s all very inflated,” explains Amber WH. “The culture of this is that you shouldn’t care about anyone other than yourself and the person you want to be with.”

That would put a strain on everyone’s relationship – but Amber says it’s especially difficult for Paradise candidates because they juggle other factors that don’t come into play in real life. “Kindness is somehow swept under the rug,” she says. “And kindness is one of the most important things you look for in a relationship with someone.”

This applies to both men and women, she adds. “In terms of matchmaking, it’s a word that is used quite a lot: ‘You have to be kind.'”

This season, Amber says she “really felt for the cast” and the tricky dating situations they got into. But overall, she rates the candidates themselves as pretty good matchmakers. “They are banding together, but if I had a choice I would say, ‘Yeah, I would bring the two together. And I would definitely bring these two together,'” she said.

Maurissa Gunn and Riley Christian

Craig SjodinGetty Images

Amber’s judgment? Maurissa and Riley are a great pairing, but she’s not sure if they’re built to last. “I really thought he was so cute with Marissa,” she says. “It will break my heart to see what happens, but I really like her.

Her only red flag is Riley’s laid-back attitude. “I just feel like he’s a little more of a charmer,” says Amber. But guys like that “can turn into good guys,” she added. “I watched him like, ‘Is this his time? Will he be that guy? And he doesn’t have enough camera time to tell me. “So the jury has not yet decided on these two.

Brendan Morais and Pieper James

abcs

Craig SjodinGetty Images

The couple fans love to hate actually have more staying power than you might think. “They seem totally in love with each other,” says Amber. “But the thing is, Brendan is not only assertive, but he’s also out of control of his own emotions. And so he could implode himself.”

“He doesn’t seem to really have his own feelings,” she adds. “Something is wrong with him.” Amber says her real tip was to see how Brendan acted around Natasha. “He couldn’t even be straight with her,” she explains. “I was like, ‘Wait a minute. You’re not even able to say the words you’re thinking.'”

And the future of Brendan and Pieper? “I think he looks cute with Pieper and they have chemistry,” decides Amber.

Joe Amabile and Serena Pitt

abcs

Craig SjodinGetty Images

Let’s get one thing straight, “It’s really clear that he really, really, really likes his ex, Kendall,” says Amber. “And he’s not 100 percent honest, but that’s because he doesn’t really want to stick to Kendall.”

ICYMI, Joe, and Kendall originally split because he wanted her to move to Chicago with him, and she said no. (Fair enough.) But Amber thinks “if she had come” [on Paradise] and said, ‘Listen, I’m in love with you and I want to move to Chicago and give us a real chance,’ “then Joe would have left Serena sooner than Wells Adams can make a cocktail.

“His feelings are real for her, and he could fall in love with her again right in front of Serena,” says Amber. “I really don’t know what’s going to happen to them, I can’t tell – but he really likes them both.” Sounds like the producers focused on the wrong love triangle, if you ask me.

Kenny Braasch and Mari Pepin

abcs

Craig SjodinGetty Images

Kenny and Mari win first place for Paradise’s cutest couple as far as Amber is concerned. Although Kenny got distracted by Demi Burnett in the first few episodes, Amber says, “He seems like a really nice guy and I think he’s probably really ready to settle down. Mari seems like a really suitable partner for him.”

Her age difference of 15 years doesn’t let her upset either: “She’s very grown up,” Amber adds. She thinks Mari is a great partner who shares her feelings with Kenny from the start. “I think there’s a chance these two might actually work,” Amber told WH.

Abigail Heringer and Noah Erb

abcs

Craig SjodinGetty Images

“I love Abigail and Noah,” says Amber. But she really wants these two lovebirds to “have more sparks. They are something of a married couple”. Because of this lack of chemistry, she is “not sure what will happen to these two” (even if they are the butter of each other’s toast).

Becca Kufrin and Thomas Jacobs

abcs

Craig SjodinGetty Images

At first glance, Amber says, Becca and Thomas are actually a pretty cute couple. “I think they make a lot of sense,” she explains. “I think that is Tammy [Ly] suited him strangely. “

Amber adds that Thomas and Becca go well together visually. “When I look at Thomas’ stature, his build, and then all of the women, you think, ‘Okay, it has to be Becca.’ It’s big, it’s statue-like, it’s the Bachelorette. So it makes sense. “

But in terms of relationship, this duo just isn’t built for the long haul. “She can do so much better,” says Amber. “In the end, is that really the guy you’re going to end up with?” So she won’t be surprised if the two split up: “If they get married, I still say it’s not a match until they split up and she says, ‘He cheated on me and he’s an idiot.’ And I would say, ‘There it is!’ “

Sounds like Bachelorette Katie Thurston was right when she warned the other Paradise ladies to stay away from Thomas on Us Weekly.

Tre Cooper and Tahzjuan Hawkins

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Craig SjodinGetty Images

Despite Tahzjuan’s previous affair with Tres uncle, these two actually seemed like a great couple. “It was cute,” says Amber of their brief relationship. “And he was one of my favorites.”

Amber was disappointed that Tahzjuan had dropped her association with Tre as soon as Riley arrived. She also believes the Paradise producers cut out some footage that would have made Tahzjuan’s decision more meaningful. “One night she just screamed on the beach and Tre was kind of outside. And I asked, ‘What actually happened?’ “Says Amber.

Aside from glitches and missed connections, Amber thinks Tre and Tahzjuan should try again. “The two of them should at least meet up when they get home,” she says. (Personally, I fully and completely agree!)

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Women’s Health

United Women’s Empowerment Hosts Town Halls to Hear Women Workers’ Concerns

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United Women’s Empowerment hosted a virtual city hall for working women in mid-Missouri on Tuesday. Hosting events both virtual and in person across the state this fall, the organization says its goal is to hear feedback from Missouri women and find solutions to the economic obstacles they face.

“It really is an opportunity for women to talk about the recovery from COVID-19 and the economic barriers and challenges women face in their families,” said Wendy Doyle, President and CEO of United WE.

The town halls are an initiative of United WE’s recently established Women’s Economic Development Task Force. Moderators asked survey questions and answered participants’ comments.

A major issue was access to the Paycheck Protection Program or PPP loan. According to the Missouri Department of Labor and the National Association of Women Business Owners, only 53 percent of women entrepreneurs had access to PPP loans, compared with 72 percent of women entrepreneurs in Missouri as a whole.

For women entrepreneurs of color, the number was even lower.

“Those who have a relationship with their banker have successfully secured PPP funding,” said Doyle. “But a lot of women don’t have a relationship with their banker, and that’s something that really caught on in town halls.”

The discussion also touched on mentoring, paid time off, access to health care, and an examination of the barriers for women applying for local office.

“Childcare is a huge pain point during COVID. In the best of times, it’s a huge pain point. ”

Kathy Wunderlich

The majority of attendees stated that internet quality and access were not a significant issue for them, but it should be noted that this town hall was held virtually – so those facing connectivity issues may not be able to attend.

However, both rural participants and some from lower-income neighborhoods pointed out that the cost of Internet access can be prohibitive despite the infrastructure in place.

Kathy Wunderlich is a Program Associate of the Hawthorn Foundation and attended City Hall.

“Childcare is a huge pain point during COVID,” said Wunderlich. “In the best of times, this is a huge pain point.”

Concerns about childcare ranged from fear, lack of socialization and educational delays, to expiring subsidies for day care centers.

41 percent of all Missouri counties have no approved childcare facilities. This emerges from a November 2020 report commissioned by thgat United WE from the Institute of Public Policy at the Harry S. Truman School of Public Affairs on the economic status of women in Missouri.

United WE will host two more in-person events in October: 11:30 am on October 6th at the Kansas City Chamber of Commerce and 11:30 am on October 14th at Truman State University in Kirksville. Free childcare is offered in both.

The next virtual town hall meeting will take place on October 28th from 5.30pm to 6.30pm. You can register for these events at united-we.org/mo-town-halls.

This year marks the 30th anniversary of the organization. United WE was founded in Kansas City and is a non-profit, non-partisan organization. Her mission is to address systemic barriers women face through research and political advocacy.

To learn more about the organization, visit http://www.united-we.org/ or follow @UnitedWeEmpower.

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