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Women’s Health

Medicine’s Failure With Women in Pain

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I became a sick woman 10 years ago. In October 2010, the cause of the strange pain that had haunted me for years was finally uncovered and I was diagnosed with systemic lupus erythematosus (SLE), a chronic autoimmune disease that is the most common form of lupus. Ninety percent of the estimated 3.5 million people who have it are women. Like many other autoimmune and chronic diseases that disproportionately affect women – including multiple sclerosis, Graves’ disease, myasthenia gravis, rheumatoid arthritis, and endometriosis – SLE is incurable and its cause is not fully understood.

In the years since my diagnosis, as I learned to live with my mysterious, unpredictable disease, I looked for answers through my medical history. Unwell women, like so many Russian nesting dolls, emerged from the annals of medicine. Their medical histories often followed similar patterns: childhood illnesses, years of pain and mysterious symptoms, and repeated misdiagnosis. These women were part of my story. But the observations of their disorders and symptoms in clinical trials told only a fraction of their stories. Notes on their cases gave clues about their bodies but said nothing about what it meant to live in them.

I tried to imagine what it felt like to be a sick woman struggling with an illness that defied medical understanding at these different points in history. I felt a close relationship; we shared the same basic biology. What has changed over time is not the female body, but medicine ‘s understanding of it.

The author, who suffers from the most common form of lupus, was photographed at her home on June 8th.


Photo:

Dylan Thomas for the Wall Street Journal

Specters of doubt and discrimination have haunted medical treatises on women’s health since ancient Greece. The authors of the Hippocratic Corpus, the fundamental treatise on Western medical practice, spoke of the “inexperience and ignorance” of women about their bodies and their diseases. In the 17th century, hysteria emerged as an explanation for a variety of symptoms and illnesses in women. Derived from the ancient Greek word hystera, which means uterus, it was originally believed that hysteria originated from the reproductive organs, which have been considered the source of many female diseases since the Hippocratic era.

In the 19th century, female hysteria “took center stage” and “became the explicit topic of numerous medical texts”, especially when the cause of an illness was not immediately apparent, wrote the British medical historian Roy Porter in “Hysteria Beyond Freud”. . “As the cultural critic Elaine Showalter has shown in her influential story“ The Female Malady ”, well-known doctors and psychiatrists of the time linked hysteria with the perceived tendency of women to fabricate symptoms for attention and sympathy.

Prejudices about the body, mind and life of women have cast a long shadow over modern clinical and biomedical knowledge. Graves’ disease, an autoimmune thyroid disease that affects 70-80% more women than men, had “female nervousness” in its earliest descriptions in 1835 and was even labeled psychosomatic, even after its autoimmune causality was discovered in 1956. Many women with myasthenia gravis, an autoimmune neuromuscular disease first mentioned in 1877, were diagnosed as mentally ill and dismissed as hypochondriac until the 20th century. Multiple sclerosis has been known to be more common in women since the 1940s, but this prevalence has long been obscured by the assumption that the neurological and motor disorders in women are nervous or hysterical.

In 1955, chronic disease specialists at Johns Hopkins revealed that over the past decade, several women who were eventually diagnosed with lupus had undergone unnecessary psychiatric and surgical procedures – including electroshock therapy, insulin coma, and hysterectomy – after doctors misdiagnosed their chronic physical pain diagnosed as a symptom of emotional instability. Ulcerative colitis, a chronic bowel disease that affects the reproductive and sexual functions of women in poorly understood ways, has historically been considered to be caused by psychological distress. The recommended treatment for patients in the 1950s was prefrontal lobotomy.


As a result of a groundbreaking study in 2001, the gender pain gap was widely recognized only a generation ago.

Until almost the end of the 20th century, clinical studies and biomedical research relied disproportionately on male subjects and male laboratory animal models. US law of 1993 required the appropriate involvement of women and minority members in projects funded by the National Institutes of Health. This led, for example, to the first large-scale research on the preventive effects of aspirin on cardiovascular disease in women; previous studies had only men enrolled.

As a result of the groundbreaking 2001 study, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” the gender pain gap was generally recognized only a generation ago. Authors Diane Hoffmann and Anita Tarzian, academics in medical ethics and health law at the University of Maryland, showed, based on clinical data and sociological research collected since the 1970s, that women were more likely to be prescribed sedatives and antidepressants than referred to diagnostic tests Chronic Pain Self-Assessment. They attributed this inequality to the fact that female pain is “more emotional and therefore less believable”.

Recently, a Swedish team analyzed research on gender and pain published in the US, UK and Europe since 2001 and concluded that women are still more “psychologized” and “taken less seriously” than men’s pain .

Reports from 2019 and 2020 from two related teams based in Toronto analyzed studies on the treatment of heart disease and depression and found that women received fewer referrals and procedures than men. Women were also more likely to describe poor communication with their doctors. The reports suggested that the development of specific “patient-centered” treatment regimens in treating women, including training clinicians in “active listening” and “asking questions”, may change the dynamics, but there has been little practical research into introducing them Practices.

One ray of hope is the increasing number of female doctors. Women themselves report better outcomes in diagnosis and treatment when they are cared for by female doctors, and female patients are more likely to survive a heart attack if their doctors are female, according to a 2018 report by the National Academy of Sciences. Although the number of men among active US doctors is still higher than that of women, women made up 36.6% of the field in 2019, an 8 percentage point increase from 2007.

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Have you, family or friends seen that health problems are too easily dismissed by women compared to men? Join the conversation below.

Last year, the Covid-19 pandemic demonstrated the importance of integrating gender differences into medical research. Studies show that women, especially over 55, are more likely to experience persistent post-viral symptoms such as shortness of breath, fatigue, and brain fog. Women also seem to experience more side effects after vaccination, including some that are life-threatening, but the extent and severity of possible risks are not yet understood.

Today, the exact reasons for the gender inequality in the incidence of my disease, SLE, are still largely mysterious, although researchers recognized its prevalence in women more than a century ago. More research is urgently needed to understand how and why confusing chronic and immune-mediated diseases and conditions affect women in far greater numbers, but women also need to be valued more as accurate reporters of their own experiences of pain and illness. Many of the answers lie in the bodies of women and in the stories their bodies have been writing for centuries.

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Women’s Health

Putting artificial intelligence at the heart of health care — with help from MIT | MIT News

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Artificial intelligence is transforming industries around the world – and healthcare is no exception. A recent Mayo Clinic study found that AI-assisted electrocardiograms (EKGs) have the potential to save lives by speeding up the diagnosis and treatment of heart failure patients treated in the emergency room.

The study’s lead author is Demilade “Demi” Adedinsewo, a non-invasive cardiologist at Mayo Clinic who actively integrates the latest AI advances into cardiac care and draws heavily on her learning experience with MIT Professional Education.

Identifying AI opportunities in healthcare

Adedinsewo is a dedicated practitioner and a Mayo Clinic Florida Fellow for Women’s Health and Director of Research for the Cardiovascular Disease Fellowship program. Her clinical research interests include cardiovascular disease prevention, women’s heart health, cardiovascular health disparities, and the use of digital tools in the treatment of cardiovascular disease.

Adedinsewo’s interest in AI became apparent towards the end of her cardiology fellowship when she began researching its potential to transform the healthcare industry. “I started to wonder how we could use AI tools in my field to improve health equity and reduce inequalities in cardiovascular care,” she says.

During her fellowship at Mayo Clinic, Adedinsewo began studying how AI with EKGs could be used to improve clinical care. To determine the effectiveness of the approach, the team used deep learning retrospectively to analyze EKG results from patients with shortness of breath. They then compared the results to the current standard of care – a blood test analysis – to see if the AI ​​improvement improved the diagnosis of cardiomyopathy, a condition in which the heart is unable to pump blood adequately to the rest of the body . While understanding the clinical implications of the research, she found the AI ​​components challenging.

“Although I have a degree in medicine and a master’s in public health, these qualifications are not really enough to work in this field,” says Adedinsewo. “I was looking for a way to learn more about AI so that I could speak the language, bridge the gap and bring these groundbreaking tools to my field.”

Building a bridge at MIT

Adedinsewo’s desire to bring together advanced data science and clinical care led her to MIT Professional Education, where she recently completed the Professional Certificate Program in Machine Learning & AI. To date, she has completed nine courses, including AI strategies and roadmap.

“All of the courses were great,” says Adedinsewo. “I particularly appreciate how the faculty, like Professors Regina Barzilay, Tommi Jaakkola and Stefanie Jegelka, have provided practical examples from healthcare and other areas to illustrate what they have learned.”

Adedinsewo’s goals are closely aligned with those of Barzilay, the AI ​​director at the MIT Jameel Clinic for Machine Learning in Health. “There are so many areas of healthcare that can benefit from AI,” says Barzilay. “It is exciting to see how practitioners like Demi participate in the discussion and help to find new ideas for effective AI solutions.”

Adedinsewo also valued the opportunity to work and learn in the larger MIT community with experienced colleagues from around the world, and stated that she learned different things from each person. “It was great to get different perspectives from students using AI in other industries,” she says.

Putting knowledge into practice

Equipped with their updated AI toolkit, Adedinsewo was able to make significant contributions to the research of the Mayo Clinic. The team successfully completed and published their EKG project in August 2020, with promising results. When analyzing the EKGs of around 1,600 patients, the AI-assisted method was both faster and more effective – it outperformed standard blood tests with a measure of performance (AUC) of 0.89 versus 0.80. This improvement could improve health outcomes by improving diagnostic accuracy and increasing the speed at which patients receive adequate care.

But the benefits of Adedinsewo’s MIT experience extend beyond a single project. Adedinsewo says the tools and strategies she acquired have helped her communicate the complexities of her work more effectively and expand its reach and impact. “I feel better able to explain research – and AI strategies in general – to my clinical colleagues. Now people turn to me and ask, ‘I want to work on this project. Can I use AI to answer that question? ” She said.

Look into the AI-supported future

What’s next with Adedinsewo’s research? Mainstream AI in cardiology. Although AI tools are not currently widely used in evaluating patients at the Mayo Clinic, she believes they have the potential to have a significant positive impact on clinical care.

“These tools are still in the research phase,” says Adedinsewo. “But I hope that within the next few months or years we can do more implementation research to see how well they improve care and outcomes for heart patients over time.”

Bhaskar Pant, Executive Director of MIT Professional Education, said, “At MIT Professional Education, we’re particularly excited to be able to bring real-world insights and tools into machine learning and AI from MIT experts to health researchers like Dr. Demi. Adedinsewo working on ways to significantly improve clinical care and health outcomes in cardiac and other patient populations. This is also in line with MIT’s mission to ‘work with others for the good of humanity!’ “

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Women’s Health

Health: Perimenopause: Symptoms can begin long before your periods stop – and it’s impacting women’s mental health

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A senior gynecologist explains the importance of empowering women with perimenopausal symptoms to Abi Jackson.

We’re finally talking more about menopause, but what about perimenopause?

Just like menopause, it can have a significant impact – especially emotionally and mentally. 86% of women said they had mental health problems as a result, according to a new survey from Healthandher.com.

For 58%, low energy and motivation were the main problems, while 53% said they were low mood and depression, along with anxiety (50%), anger, and mood swings (42%). One in ten women even said they had thoughts of suicide, according to a survey of 2,000 British women.

View this post on InstagramA post posted by Dr. Nitu Bajekal MD FRCOG IBLM (@drnitubajekal)

So what do women need to know? We worked with leading gynecologist Dr. Nitu Bajekal (nitubajekal.com) spoken to learn more …

What is perimenopause?

Menopause, in general, is when your periods stop and you haven’t had a period for 12 consecutive months. It’s a natural part of aging that occurs when estrogen levels drop, but it can cause a variety of physical and mental symptoms that can range from mild to debilitating. “The median age for menopause is between 45 and 55 years old, with most going through menopause around 51,” says Dr. Bajekal (although some may experience it even earlier).

“Perimenopause means ‘menopause in transition’. It is the time that leads to a complete missed period. This usually takes about four years but can take anywhere from two to eight years 45, some women with perimenopause can have symptoms by their late 30s, and many people don’t know it. ”

What are the signs of perimenopause?

The symptoms are basically the same as during menopause – such as hot flashes, difficulty sleeping, decreased sex drive, depression, anxiety, and just not feeling like yourself. Some people experience things like brain fog and difficulty concentrating. With perimenopause, Dr. However, Bajekal states that the symptoms can “increase and decrease” and your periods become irregular for a few months and then return to normal for a while.

This up and down pattern can amplify the mental health effects: “Sometimes you may think you’re going crazy for having symptoms for two or three months, but then you don’t, your hormone levels are fluctuating. ‘Did I imagine that? Is that really happening? ‘”

Why is perimenopause awareness important?

Dr. Bajekal agrees that there is “a lack of awareness” among women themselves and sometimes health professionals. This means that women may not just miss out on treatments and advice that might help them. Not knowing exactly what is going on can make the problems worse. “Empowering women with knowledge is the key, because once you know something, you are not afraid of it,” says Bajekal. “You don’t think too much, your brain doesn’t go into overdrive and think, ‘Oh God, what’s wrong with me? Do I need antidepressants, why sometimes don’t I feel like doing something, why do I feel a little bit? removed from my relationship? ‘”

Dr. Bajekal says it is important that women do not feel “fobbed off” by their general practitioners. But it’s also important that doctors investigate other possible causes if necessary: ​​”Because people can be depressed, for example. But the point is to be open to the idea that perimenopause also needs the attention it doesn’t. ” [been getting]. ”

How Can Your Doctor Help With Perimenopause?

Tests don’t diagnose perimenopause, Bajekal explains (although some people get tests done to look for other possible causes). However, if you have symptoms that suggest perimenopause and it is adversely affecting you, you can try hormone replacement therapy. Your GP may schedule a try to see if it helps.

What if your doctor just refuses or tells you to come back at 50? Dr. Bajekal recommends asking about someone who has a particular interest in the subject. “In the family doctor group there will be people who have a special interest in things like cholesterol, high blood pressure, diabetes, women’s health and menopause,” she says.

Knowledge is power

As mentioned earlier, Dr. Bajekal that it can be very helpful to have these conversations and have your concerns explained and confirmed. “It’s about becoming more aware of the symptoms and the condition, and then women can decide what they need,” she says. “Do I just need to know more about it so that I feel empowered? Do I need a hormone replacement?

View this post on InstagramA post posted by Dr. Nitu Bajekal MD FRCOG IBLM (@drnitubajekal)

She is also a big advocate of the role of lifestyle, citing diet, sleep, and regular exercise as key. Bajekal says a diet full of plants and whole foods – high in legumes, beans, whole grains, soy, green leafy vegetables, and fruits – is high in fiber, nutrients, and plant-based estrogens. This is great news for health in general and for perimenopausal support to help balance hormones and inflammation.

“And stress,” says Bajekal. “Identify your sources of stress and find ways to deal with it, whether it be through breathing exercises, yoga, meditation, walking with a friend. Avoid alcohol, excessive caffeine, and smoking; all of these can make menopause and perimenopause worse. Whether you use medication ingestion or not, “she adds,” the lifestyle should always be there – the diet, exercise, laughing with friends, and taking care of your sanity. ”

Never ignore red flags

Dr. Bajekal’s last advice? Even if you are pretty sure that you are in perimenopause, never ignore any gynecological changes that may need more thorough investigation and stay up to date with swab tests. “I see it every day, patients who have been told, ‘Don’t worry, you have heavy periods because you are going through menopause.’ No – it’s not normal. If you have heavy periods, very irregular periods, new pain in your period, you shouldn’t ignore it. And if you have pain or bleeding after sex, make sure this is investigated. ” It could be nothing, or something else – possibly serious – could happen. The review of things will either put you at ease or make sure you are dealt with quickly.

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Women’s Health

Menopause: Answering your queries

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Menopause can often be easily dismissed as a hot flash or two. It is so much more, but a serious lack of understanding and awareness can diminish any person’s experience of menopause. This can result in no questions being asked, which limits the ability to make informed decisions. When it comes to menopause, there are no awkward or ridiculous questions. Learning about menopause is crucial. Always ask.

Dr. Caoimhe Hartley founded Menopausal Health in 2021 to make menopausal women easier to access to the best advice and care. Dr. Hartley is committed to women’s health and is aware of the difficulties women face in understanding and navigating their menopause. Dr. Deirdre Lundy, of the Bray Women’s Health Center, is a women’s health specialist and leads menopausal training for Irish GPs at the Irish College of General Practitioners.

You are responding to some of our menopause concerns here.

I’m 49, but I’m not going through menopause. Does every woman have menopausal symptoms?

“Most women experience perimenopausal or menopausal symptoms,” says Dr. Hartley. “It can affect their mood, sleep, or physical symptoms such as hot flashes or night sweats. Some women may experience vaginal dryness or bladder symptoms. The loss of bone density that occurs when our estrogen production drops during menopause is largely silent.

“Fortunately, however, there is a percentage of women who have no symptoms at all. Likewise, not all postmenopausal women experience significant loss in bone density. Why some women have symptoms and others don’t may depend on genetic factors. If you have missed your period for more than a year [and you are over the age of 50], you can be sure that you are going through menopause. “

My body aches. Is that a sign of menopause?

“Generalized pain is common during menopause,” advises Dr. Hartley. “This may be due to the loss of estrogen, which has some weak anti-inflammatory properties. Similar symptoms have been seen with aromatase inhibitors, which are anti-estrogen drugs that are sometimes used in patients with breast cancer.

“This pain can have secondary effects, including lack of sleep and decreased ability to exercise or be active. Living with pain can also negatively affect our mood. You may find that an old injury is flaring up again or it is a completely new symptom. Know that you are not alone and that there are ways you can help. Joint pain can also be due to other causes such as osteoarthritis, inflammatory arthritis, and other conditions. It is always a good idea to discuss this with your GP as you may need further tests. “

My symptoms are relentless. What can I do?

“A lot,” says Dr. Hartley. “The first step is to get advice and help. Do not suffer in silence! The route of treatment will depend on what symptoms you are experiencing, what background health risks and levels you may have. I usually start by talking to patients about lifestyle interventions, exercise, CBT. to entertain [cognitive behavioural therapy], Reducing caffeine and alcohol, and a discussion of sleep hygiene, etc.

“There are also non-hormonal and hormonal options for treating menopausal symptoms. estrogen [as part of hormone replacement therapy] is most effective for treating symptoms such as hot flashes and night sweats, as well as vaginal symptoms, and also protects against the development of bone loss and osteoporosis.

“If lifestyle changes do not relieve menopausal symptoms, and this is often the case, we recommend speaking to a doctor who has been trained in menopause,” says Dr. Lundy.

I’m going through menopause and so anxious. Is that normal?

“It is very common for mood swings and anxiety to change during menopause,” says Dr. Hartley. “Many women report a loss of self-confidence, low self-esteem, irritability or loss of motivation. Sometimes these symptoms come and go and can be mild. For others, they can be debilitating.

“Women who have had a history of depression, anxiety, significant premenstrual symptoms, or postnatal depression / anxiety may be at greater risk of developing mood or anxiety disorders at the time of menopause. It is important to speak to your GP about the many options for treating all of these symptoms. “

Menopause ruins my sex life. What can I do?

“It depends on so many factors,” says Dr. Hartley. “What are the underlying problems affecting your sex life? Do you have vaginal dryness that makes sex uncomfortable or painful? Are you suffering from poor sleep or a bad mood? There are many things that can affect sexual desire and function. I would advise you to speak to your family doctor. “

I am full of anger! Why is this happening to me?

“There can be many reasons for this,” says Dr. Hartley. “The fluctuating levels of estrogen that occur during perimenopause [the years of hormonal changes that lead up to menopause, the final period] can have a huge impact on mood, irritability, anxiety, and self-confidence. Estrogen plays an important role in our nervous system and affects the production of neurotransmitters, the expression of hormone receptors in our brain and the protection of our nerve cells from damage.

“Anger is not uncommon during menopause. It has to be tackled with healthcare, ”says Dr. Lundy. “HRT can help, but sometimes hormonal changes during menopause only trigger the onset of underlying mental disorders such as bipolar disorder, severe anxiety, and depression.

“The susceptibility to mood swings or irritability is compounded by poor sleep, fatigue, and other possible symptoms,” advises Dr. Hartley. “Know that you are not alone and that there are many options to help you cope.”

Is Hormone Replacement Therapy Right For Me?

“This question is very difficult to answer because it depends on so many different factors,” says Dr. Hartley. “Hormone Therapy in Menopause” [HRT] is one of several different treatment options that we have to help women relieve symptoms of menopause. HRT also protects against bone density loss and can reduce the risk of cardiovascular disease in some women. It depends on your own background risk and the symptoms you are trying to treat. It depends on your own health values ​​and goals.

“For the majority of women, the benefits of hormone therapy for both symptom relief and health improvement outweigh the potential marginally increased risks. The type of HRT, what hormones are prescribed, and how long you take them are also important when considering the risk. Again, for most women, the benefits outweigh the risks. How long you take HRT is also very individual and there is no arbitrary age or how long you need to stop taking your medication.

“It is important to consider lifestyle factors such as smoking, physical activity, alcohol consumption and diet that can affect the long-term risk of developing osteoporosis or bone density loss and cardiovascular disease.

“It’s also important to have your blood pressure and cholesterol checked annually, and to keep up to date with breast and cervical checkups. There are many alternatives to HRT, but these depend on the symptoms affecting your quality of life and thus the goal of treatment. Whichever treatment path you choose, you should be well informed and discuss in detail with your doctor what is the best option for you. “

How long until I feel like myself again?

“This question is difficult to answer,” replies Dr. Hartley. “The duration and severity of the symptoms depend on many factors and are very individual. The average duration of hot flashes and night sweats is five to seven years. Most symptoms will improve over time, but some problems, such as vaginal dryness and discomfort, may get worse over time. “

Dr. Lunday says, “Most women between the ages of 55 and 60 feel a lift. Others can be stressed for much longer and remember that some women have no symptoms at all. “

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