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Women’s Health

First, do no harm? Medicine’s unbelievable, sometimes horrific treatment of women

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Hippocrates, the founder of modern medicine, believed that women were controlled by their uterus. The father of modern gynecology, James Marion Sims, experimented with enslaved black women without anesthesia in the mid-19th century and believed they felt less pain than white women. (His statue stood in New York’s Central Park for more than a century before it was removed in 2018.) Doctors claimed that women’s suffrage would harm the fragile bodies and diminished minds of women. Such examples cast a hideous shadow on “first, do no harm”.

The history of medicine is as social and cultural as it is scientific, and male dominance is firmly anchored in its foundations. But even the author Elinor Cleghorn, who last year dealt with the history of women’s relationships with medicine, was surprised “how deliberate and insidious it was,” she says. “Biological theories about female bodies have been used to strengthen and perpetuate restrictive societal ideas about women.”

Doctors could tell me what was happening in my body, but they couldn’t tell why I got systemic lupus or why I am more prone to it as a woman

Cleghorn’s new book, Unwell Women, enumerates a litany of ways in which women’s minds and bodies have been misunderstood and misdiagnosed throughout history. From the wandering uterus of ancient Greece (the idea that a displaced uterus caused a lot of women’s diseases) and the witch trials of medieval Europe, to the onset of hysteria to modern myths about menstruation, she lays out the incredible and sometimes terrible treatment of women for millennia in the name of medicine.

A former Oxford researcher with a background in feminist culture and history, Cleghorn meticulously constructs an often terrifying framework to show how and why the patriarchal medical world is so harmful to women, especially underserved women and women of color. And Unwell Women shows how the legacy of disenfranchisement and discrimination continues today, resulting in women being underrepresented in medical studies, women’s pain being psychological or emotional, and an inadequate, sometimes hostile system that women tend to be Offers antidepressants and sedatives as a referral for further diagnosis and more targeted care.

Cleghorn was inspired to write the book after years of being discharged from doctors before she was finally diagnosed with systemic lupus, a difficult-to-diagnose disease that is nine times more common in women than men. (Pop star Selena Gomez has spoken openly about her struggles with the complex, incurable disease.)

“I was trying to understand why none of my doctors could really explain much about it. They could tell me what was happening in my body, but they couldn’t tell why I got it or why I am more prone to it as a woman. I started digging through the history of medicine and finding women who really felt like me in case studies. ”(Cleghorn began writing the book during the lockdown, relying on online medical archives and the extensive ones Wellcome Library digital collections. “Fortunately for me, the men who wrote about women’s bodies love to write a lot about them,” she chuckles.)

There is a quiet radicalism in using women’s knowledge of themselves to transform the culture of medical inequality

These “related women” brought Cleghorn to learn about other chronic, incurable diseases that affect more women than men. One of these diseases is endometriosis, which affects an estimated one in ten women worldwide and whose diagnosis takes an average of seven to nine years. Although it was named in the 1920s, all of its diagnostic secrets remain to this day, notes Cleghorn. “Endometriosis was described by a doctor in the 1920s as the enigma of etiology, and we still don’t know what causes it. Tracking this lack of progress over 100 years has been a real example of how little progress we have made. I wanted to go back and find out why these conditions are still surrounded by so many question marks and where these gaps, injustices and discrimination actually come from. “

Today’s booming wellness industry, which, according to Cleghorn, benefits most from women and whose popularity is related to the prevalence of such confusing diseases, has fallen into the breach. “The industry knows that women with these health problems are being let down by traditional medicine, so it adapts to being caring, listening, and seeing you as an individual. A lot of language in the wellness industry strikes me as frightening the 19th century with its conditions and syndromes. “

Throughout the book, Cleghorn highlights the increasing effects of race, access, and privilege on gender. “In the UK, we have faced our health failures in black, Asian and ethnically diverse women, who have far greater health disparities than white women, especially in reproductive health,” she notes. But she is dismayed by the “very reassuring” response from the British government. “It’s annoying and shocking that there is no more money, strategy, funding, research, and urgent prioritization of issues like the maternal mortality of black women.”

It is probably the first time in history that women’s subjective experiences and voices are used. This is an important start because women are not a monolith

Parallel to this story of frustrations and injustices, there is an empowering alternate story of resistance and beneficial contributions from women. She quotes the pioneering American doctor Mary Putnam Jacobi, who in the 1870s denied the idea that women need rest during menstruation. “At that time, men doctors only used anecdotes and guesses, but Putnam Jacobi used the subjective knowledge of women to conclusively refute them. There is a quiet radicalism in using women’s knowledge of themselves to change the culture of medical inequality. “

Cleghorn relies on this with a final chapter entitled Believe Us. For a long time women were considered to be unreliable narrators of their own bodies. Although modern medicine today enables women to educate themselves about their bodies (a luxury that has been banned for centuries) and offers women the opportunity to enter the medical community, Cleghorn believes that understanding women’s health continues to be a problem remains.

But getting started with a solution is easy, she says. “It’s really important to prioritize women’s voices. I don’t think all of this is a grand patriarchal conspiracy – implicit, unconscious bias is so ingrained, even in the very establishment of doctor-patient interaction. When I have the opportunity to speak freely without feeling rushed or judged, I feel better cared for. “

The UK government’s recent women’s health strategy, in which they seek evidence from women about their treatment by the health system, is groundbreaking, she notes. “It is probably the first time in history that the subjective experiences and voices of women are used. This is an important start because women are not a monolith. “

Cleghorn hopes her book will help anyone who has had a difficult or painful health experience “feel validated and valued because it can be so isolating, so demoralizing, and dehumanizing. But having a disease also makes sense insofar as you are part of that production of very important knowledge. I hope readers can relate to this story, which we hope we can change now. ”- Wächter

Unwell Women, by Elinor Cleghorn, is published by Weidenfeld & Nicolson

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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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