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Women’s Health

Autoimmune Illnesses and the Big Unknown

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In ancient Greece it was thought that the uterus could wander through the body feverishly looking for sperm in order to conceive.

Sometimes the uterus was lost a little.

When this happened it was said to be terrible afflictions for an individual. If the uterus finds its way to the chest, it can cause shortness of breath or chest pain. If it reaches the head, migraines or headaches can occur.

The cure for this all-rounder disease? Pregnancy. If the oh-so-hungry uterus could find sperm and cling to a child, it would no longer have to wander around relieving sufferers of all ailments.

In the following millennia, women were considered particularly prone to “hysteria” (the word derives from the Greek hystera or uterus), what became a collective term for all physical problems faced by women that had no obvious cause, from depression to migraines to “emotional attitude”. Hysteria has been widely viewed as a unique female ailment. From the wandering days to Freud’s ideas that penis cravings were at the root of women’s mental health problems, men were rarely diagnosed with hysteria, although men were diagnosed with that diagnosis in the late 19th century. For the most part, hysteria was treated by methods that had no clinical value and could often be harmful. Charlotte Perkins Gilmans The yellow wallpaper captivated the audience with his fictional (but often viewed as semi-autobiographical) Report of treating a woman for what we now know as postpartum depression but was then diagnosed as “hysteria”. Her treatment included prohibiting work or writing. It was not until 1980 that hysteria was deleted from the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The diagnosis of hysteria may no longer exist, but the treatment of diseases that predominantly affect women remains somewhat confused. One of the most serious of these problems is the diagnosis and treatment of autoimmune diseases.

Autoimmune diseases like rheumatoid arthritis (RA) and psoriasis occur when the body’s immune system attacks itself. More than 24 million people in the United States alone have at least one of the more than 100 identified autoimmune diseases, with many having several different diseases.

Does gender play a role in our understanding of autoimmune diseases?

More than 80% of all autoimmune patients are women and a leading cause of death and disability in women aged 15 to 44 years.

These diseases are disproportionately diagnosed in women: Rheumatoid arthritis affects three times more women than men; affects systemic lupus erythematosus (SLE), the most common type of lupus seven times more women than men; and Sjörgen syndrome nine times more women than men.

For a long time and to this day, symptoms of autoimmune diseases in women have been overlooked or viewed as an exaggeration – an extension of belief in “women’s hysteria”. In an interview with iNews UK, fatigue specialist Professor Julia Newton said, “I was not taught anything about ME [an autoimmune illness that causes chronic fatigue] when I was in medical school. Even today it is very little understood and very rarely recognized as a true biological condition. Patients are misunderstood and not believed. The belief that ME is more of a mental illness than a physical illness has held the field back for years – and that may be in part because it’s a female dominance. Affected people are seen as ‘hysterical’. “

Despite the severity and frequency of these disorders, we know relatively little about most of them. To date, the exact cause of the autoimmune disease remains unclear; The general scientific consensus is that it is a mix of hormonal, genetic, and environmental factors. For example, tobacco smoking has been linked to the development of systemic lupus erythematosus and rheumatoid arthritis. Smoking further increases the likelihood of a diagnosis in people who already have a genetic predisposition to the disease. Researchers have also postulated that autoimmune diseases can be linked to the X chromosome. Because women usually have two X chromosomes, they are at higher risk of developing autoimmune diseases compared to men.

In a 2020 study, researchers found that a number of autoimmune diseases that disproportionately affect women, such as RA and multiple sclerosis (MS), are underfunded relative to the severity and burden of the disease. This continues a negative cycle regarding the lack of knowledge about autoimmune diseases: With little money, research is like looking for a needle in a haystack when we don’t even know what the needle looks like.

It is difficult to make a diagnosis

Diagnosing and treating autoimmune diseases can be an extremely difficult endeavor. On average, patients visit six doctors within four years before being diagnosed. Because many autoimmune diseases share symptoms, trying to differentiate between different diseases can be difficult and sometimes even impossible. In addition, if symptoms are too “mild”, patients may be dismissed as excessive (again, the old problem of hysteria) and may have to wait years for “more intense” symptoms to develop in order to get a proper diagnosis. Even for some of the most common conditions, such as RA or lupus, there are often no effective treatments for the disease itself. Instead, treatment focuses more on relieving symptoms than on curing a disease.

Many patients are desperate due to the lack of information. This has resulted in a dramatic increase in the use of public forums like Facebook, Reddit, and Quora to find diagnoses and treatments. On sites like Facebook, group members track all of their symptoms over a long period of time and post them in the hopes that someone else can spot what they went through and help them. These groups have significant appeal: over 38,000 people follow Facebook’s lupus support page, and over 10,000 follow the Facebook community in support of Crohn’s disease. These social media sites help people biohack their illness and collect medical data – creating new places to get help and identify new ways to treat their illness, including holistic approaches.

Biohacking and crowdsourcing

One innovation in autoimmune diseases is to take a rather “old” approach to treating the diseases – with arsenic salts. Despite its scary and deadly reputation, arsenic has a long history in pharmacy, and not just to sacrifice a spouse or two in ancient times. Before antibiotics became available, it was a common treatment for syphilis and is still a potent drug for some forms of leukemia. In 2015, Medsenic researchers found that arsenic trioxide was a safe and effective treatment for lupus and suggested that additional studies should be conducted on its use as a possible treatment. The results also spurred further investigation into the effects of arsenic on chronic graft-versus-host disease (cGvHD), an autoimmune disease in which transplanted cells, such as bone marrow cells, attack healthy, non-transplanted cells in a patient. Preliminary results have shown that the treatment has shown significant results so far.

As autoimmune diseases become more common, more and more researchers have started looking for cures. One of the most promising treatments is gene therapy. Gene therapy targets the genes in the body that cause disease. For example, gene therapy for some autoimmune diseases could target cytokines, an immune system protein that promotes inflammation in the body.

But much like our understanding of hysteria, autoimmune diseases, and female health care, our understanding of genetics has evolved a lot over time. It originally arose from discoveries that focused on the inheritance of traits from the Czech mathematician, biologist and brother Gregor Mendel. 1905 biologist William Bateson was the first to use the term “genetics”“To describe the study of heredity. Throughout the early 20th century, the study of genetics embraced the darker notions of the eugenics movement and the concept that undesirable traits could be bred from the human race through selective breeding and sterilization. This misunderstanding of genetics ultimately contributed to the concept of the “ideal” Aryan race under National Socialism, which has fortunately been condemned in the meantime.

Many genomic medical breakthroughs have involved the work of the Human genome projectwho originally worked on mapping the roughly 20,500 unique human genes, and continues today by mapping the complete genome of other organisms. Gene editing breakthroughs like CRISPR promise to be able to selectively edit genes to remove the root causes of some diseases. For example, researchers have used CRISPR techniques to control the protein ILRA (interleukin 2 alpha), which signals T cells whether to increase or decrease an inflammatory response. This could enable doctors in the future to treat autoimmune diseases by turning off the inflammatory response when it gets out of hand.

Scientists and medical service providers are also increasingly recognizing the role of epigenetics – the study of how genetic and environmental factors work together to cause changes that affect genes – to develop more effective treatment protocols and even cures. In immunology at least, the answer to the age-old question of nature vs. upbringing seems likely to be “both”.

For example, for decades it was thought that ulcers were caused by stress, a simple factor that could generally be controlled. In 1985, however, Australian researchers Barry J. Marshall and Robin Warren decided to study the role of bacteria Helicobacter pylori in ulcer development – to the point where Marshall ingests the bacteria. When he developed ulcers, the two of them demonstrated the role of infection in ulcer development, contradicting all previous medical beliefs in the field, and earned them the Nobel Prize.

The challenge is that many autoimmune treatment studies use small samples and produce mixed results, in part because most therapies target symptoms rather than the cause of the disease. This is of course because it is much easier to target a small number of genes rather than trying to correct a large number of unknown environmental factors.

The world of autoimmune diseases may still be grim, but we are learning more every day. Fortunately, gone are the days when your doctor suggested your heart murmur was caused by wandering your uterus to your chest, or using a vibrator to cure your hysteria. But until we take women’s health problems as seriously as men and devote more research money and time to research into autoimmune diseases, we hope that more data sharing and research investment will uncover better treatment options.

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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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