Monday, March 30, 2020
depression

Sexual problems are more common in postmenopausal women, which suggests that menopause can reduce libido.

The reduced sex drive is often caused by decreased estrogen levels, which can dampen arousal and result in sex being more painful.

In this article, we look at how menopause might affect someone’s sex drive, along with what can be done to improve libido.

Menopause and libido

What is menopause?

Menopause refers to when a woman stops having her period permanently, but it can affect more than a woman’s menstrual cycle.

Menopause can cause physical and emotional changes that impact a woman’s life, including her sex life.

Some symptoms and side effects associated with menopause include:

  • anxiety
  • bladder control issues
  • decreased sex drive and desire (libido)
  • depression
  • difficulty sleeping
  • thinning hair
  • weight gain

Each of these effects can impact a woman’s quality of life and relationship with her partner.

What is libido?

Libido refers to sexual interest and sexual enjoyment.

Some women going through menopause report reduced libido, but the causes vary from person to person.

According to one review, the reported rates of sexual problems in postmenopausal women are between 68 and 86.5 percent.

This range is much higher than in all women in general, which is estimated to be between 25 and 63 percent.

Why does menopause affect libido?

Decreased estrogen levels can result in reduced blood flow to the vagina, which can cause the tissues of the vagina and labia to become thinner. If this happens, they become less sensitive to sexual stimulation.

Decreased blood flow also affects vaginal lubrication and overall arousal. As a result, a woman may not enjoy sex as much and may have difficulty achieving orgasm. Sex may be uncomfortable or even painful.

Fluctuating hormone levels during perimenopause and menopause can also affect a woman’s mental health, which in turn, may cause a decrease in her libido.

Stress can also impact a woman’s libido, as she may be juggling a job, parenting, and be caring for aging parents. The changes in hormone levels a woman may experience during menopause may make her irritable or depressed, so dealing with everyday stress may feel more difficult.

According to an article published in the Journal of Women’s Health, women who have more significant side effects associated with menopause are more likely to report lower libido levels.

Examples of these side effects include hot flashes, depression, anxiety, trouble sleeping, and fatigue.

Other factors that make a woman going through menopause more likely to experience a reduced libido include:

  • history of chronic health conditions, such as heart disease, diabetes, or depression
  • history of smoking
  • engaging in low levels of physical activity

A woman should talk to her doctor about how these conditions could affect her sex drive.

Tips for improving libido

There are several steps a woman can take to increase her libido. These include medical treatments, lifestyle changes, and home remedies.

Medical treatments

middle aged couple enjoying a bike ride
Spending time together on shared hobbies, exercising, and planned dates will help increase a couple’s intamacy.

If a woman experiences changes to her vaginal tissue, such as thinning and dryness, she may wish to consider estrogen therapy.

Prescription estrogen can be applied directly to the vagina in the form of creams, pills, or vaginal rings. These usually contain lower doses of estrogen than regular birth control pills.

Some women may wish to take estrogen pills that contain higher levels of hormones. This treatment, known as hormone replacement therapy, might help reduce symptoms, such as hot flashes and mood changes, but may also carry risks.

A woman thinking about hormone replacement therapy should discuss it with her doctor before starting to take any medication.

One study found that women using hormone therapies reported higher levels of sexual desire compared with women who did not.

Less commonly, a doctor may prescribe testosterone therapy. However, not all women respond to this treatment, and the United States Food and Drug Administration (FDA) do not approve it for treating sexual disorders in women.

A woman may not experience any changes in her sex drive after using estrogen or testosterone therapies.

A woman may also choose to see a therapist who specializes in sexual dysfunction or enhancing sex. Sometimes, couples may want to attend therapy together.

Lifestyle changes

Some women may benefit from using water-soluble lubricants during sex. These can be purchased over-the-counter at most drugstores.

However, women should avoid non-water soluble and silicone-based lubricants, as these can break down condoms used to protect against sexually transmitted infections (STIs).

Increasing physical activity, such as getting 30 minutes or more of exercise on a routine basis, may help reduce menopause-related symptoms, including a low libido. Eating a healthful diet can also enhance a person’s overall sense of well being.

Changing sexual habits

There are many ways a person can foster a sense of intimacy with their partner, including:

  • Changing sexual routines: Try spending extended periods on foreplay, use vibrators or other sex toys to enhance an intimate experience, or engage in sexual activity or touching without the goal of orgasm.
  • Relieving stress together: There are many stress-relieving techniques a couple can do outside of the bedroom to increase intimacy. Examples include going on planned dates together, taking a walk, or spending time doing hobbies together, such as exercise, crafts, or cooking.
  • Practicing masturbation: Spending time alone and exploring what types of touch and sexual stimulation work well for an individual can help them talk to a partner about their needs and preferences. It can also help a person feel more comfortable with sexual activity without the pressure of a partner.

Natural remedies

Some women use natural supplements to try to increase their libido. It is important to keep in mind that the FDA do not regulate herbs and supplements, so women should be sure to choose a reputable brand.

Some natural remedies used to increase libido in women include:

  • black cohosh
  • red clover
  • soy

A woman should discuss these remedies with a doctor before taking them to ensure they will not interact negatively with other prescriptions and supplements she may be taking. Soy contains estrogen, so it may react with other estrogen therapies.

When to see a doctor

A woman should speak to her doctor whenever perimenopause or menopause is having a significant impact on her day-to-day activities, including sexual activity.

Sometimes, a doctor can recommend changes in health habits as well as discuss whether prescription medications may help relieve the symptoms, including a low libido.

Speaking with a doctor can also rule out any other underlying medical conditions that may cause a reduced libido. These conditions include urinary tract infections, uterine prolapse, endometriosis, or pelvic floor dysfunction.

Outlook

While some women do experience a decreased libido in menopause, others do not.

Some women may even experience a heightened libido after menopause. This can be due to reduced stresses over pregnancy and fewer child-rearing responsibilities.

If a woman’s libido is impacted after menopause, she should talk to her doctor about treatments that could enhance her quality of life.

Previous research has suggested that there is a link between depression and tea drinking. Now, a new study is investigating this relationship further.

Depression is common among older adults, with 7% of those over the age of 60 years reporting “major depressive disorder.”

Accordingly, research is underway to identify possible causes, which include genetic predisposition, socioeconomic status, and relationships with family, living partners, and the community at large.

A study by researchers from the National University of Singapore (NUS) and Fudan University in Shanghai raises another possibility. It finds a statistically significant link between regular tea drinking and lower levels of depression in seniors.

While the researchers have not yet established a causal relationship between tea and mental health, their findings — which appear in BMC Geriatrics — show a strong association.

Reading the tea leaves

Tea is popular among older adults, and various researchers have recently been investigating the potential beneficial effects of the beverage.

A separate study from the NUS that appeared in Aging last June, for example, found that tea may have properties that help brain areas maintain healthy cognitive function.

“Our study offers the first evidence of the positive contribution of tea drinking to brain structure and suggests a protective effect on age-related decline in brain organization.”

Junhua Li, lead author

That earlier paper also cites research showing that tea and its ingredients — catechin, L-theanine, and caffeine — can produce positive effects on mood, cognitive ability, cardiovascular health, cancer prevention, and mortality.

However, defining the exact role of tea in preventing depression is difficult, especially due to the social context in which people often consume it. Particularly in countries such as China, social interaction may itself account for some or even all of the drink’s benefits.

Feng Qiushi and Shen Ke led the new study, which tracks this covariate and others, including gender, education, and residence, as well as marital and pension status.

The team also factored in lifestyle habits and health details, including smoking, drinking alcohol, daily activities, level of cognitive function, and degree of social engagement.

In addition, the authors write, “The study has major methodological strength,” citing a few of its attributes.

Firstly, they note, it could more accurately track an individual’s tea-drinking history because “instead of examining tea-drinking habit [only] at the time of survey or in the preceding month/year, we combined the information on frequency and consistency of tea consumption at age 60 and at the time of assessment.”

Once the researchers had classified each person as one of four types of tea drinker according to how often they drank the beverage, they concluded:

“[O]nly consistent daily drinkers, those who had drunk tea almost every day since age 60, could significantly benefit in mental health.”

13,000 study participants

The researchers analyzed the data of 13,000 individuals who took part in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2005 and 2014.

They discovered a virtually universal link between tea drinking and lower reports of depression.

Other factors seemed to reduce depression as well, including living in an urban setting and being educated, married, financially comfortable, in better health, and socially engaged.

The data also suggested that the benefits of tea drinking are strongest for males aged 65 to 79 years. Feng Qiushi suggests an explanation: “It is likely that the benefit of tea drinking is more evident for the early stage of health deterioration. More studies are surely needed in regard to this issue.”

Looking at the connection the other way around, tea drinkers appeared to share certain characteristics.

Higher proportions of tea drinkers were older, male, and urban residents. In addition, they were more likely to be educated, married, and receiving pensions.

Tea drinkers also exhibited higher cognitive and physical function and were more socially involved. On the other hand, they were also more likely to drink alcohol and smoke.

Qiushi previously published the results of the effect of tea drinking on a different population, Singaporeans, finding a similar link to lower rates of depression. The new study, while more detailed, supports this earlier work.

Currently exploring new CLHLS data regarding tea drinking, Qiushi wishes to understand more about what tea can do, saying, “This new round of data collection has distinguished different types of tea, such as green tea, black tea, and oolong tea so that we could see which type of tea really works for alleviating depressive symptoms.”

Adnexal masses are lumps that occur in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or nongynecological.

An adnexal mass could be:

  • an ovarian cyst
  • an ectopic pregnancy
  • a benign tumor
  • a malignant tumor

A family doctor can usually manage benign masses. However, prepubescent and postmenopausal individuals will need to see a gynecologist or oncologist.

Malignant adnexal masses require treatment from a specialist.

In this article, we discuss the characteristics of adnexal masses. We also review how doctors diagnose and treat adnexal them.

Symptoms

People report different symptoms, depending on the cause of the adnexal mass.

People with an adnexal mass may report:

  • severe lower abdominal or pelvic pain that is usually on one side
  • abnormal bleeding from the uterus
  • pain during sexual intercourse
  • worsening pain during a period
  • painful periods
  • abnormally heavy bleeding during periods
  • abdominal symptoms, including a feeling of fullness, bloating, constipation, difficulty eating, increased abdominal size, indigestion, nausea, and vomiting
  • urinary urgency, frequency, or incontinence
  • weight loss
  • lack of energy
  • fatigue
  • fever
  • vaginal discharge

Different causes of adnexal masses may have similar symptoms, so doctors usually conduct further investigations to determine the exact cause.

Once the doctor has worked out the cause of the adnexal mass, they can recommend treatment and management.

Causes

Adnexal masses include a variety of different conditions that range in severity from benign growths to malignant tumors.

The cause of adnexal masses could be gynecological or nongynecological.

Some of the causes of adnexal masses include:

  • Ectopic pregnancy: A pregnancy where the fertilized egg implants somewhere outside the uterus.
  • Endometrioma: A benign cyst on the ovary that contains thick, old blood that appears brown.
  • Leiomyoma: A benign gynecological tumor, also known as a fibroid.
  • Ovarian cancer: These tumors of the ovary may be ovarian epithelial cancers that begin in the cells on the surface of the ovary or malignant germ cell cancers that begin in the eggs.
  • Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. It occurs due to an infection.
  • Tubo-ovarian abscess: An infectious adnexal mass that forms because of pelvic inflammatory disease.
  • Ovarian torsion: A gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts off blood flow to the ovary.

Diagnosis

A doctor may diagnose an adnexal mass by:

  • taking a complete medical history
  • asking questions about symptoms
  • conducting a physical examination
  • obtaining blood samples

Most of the time, people will need a transvaginal ultrasound to allow doctors to evaluate the characteristics of an adnexal mass.

Females who have had a positive pregnancy test result and report abdominal or pelvic pain and vaginal bleeding might have an ectopic pregnancy. An ovarian torsion causes sudden, severe pain with nausea and vomiting. Immediate medical attention is necessary to treat both an ectopic pregnancy and ovarian torsion.

People with pelvic inflammatory disease or a tubo-ovarian abscess may experience gradual pelvic pain with nausea and vaginal bleeding.

Early ovarian cancer may sometimes present with nonspecific symptoms. Sometimes, doctors may only detect cancer when the tumor has become malignant.

Malignant tumors may have one or several of the following characteristics:

  • a solid component of the tumor
  • parts of the tumor have thick divisions larger than 2–3 centimeters separating them
  • they are present on both sides of the reproductive tract
  • the presence of fluid filled lumps

Treatment

A doctor will choose the most appropriate treatment depending on the cause of the adnexal mass. Women with an ectopic pregnancy will have to end their pregnancy. A doctor may choose one of the following procedures:

  • the administration of a single or two-dose intramuscular methotrexate
  • laparoscopic surgery
  • a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes

Doctors have not yet determined the optimal management of an endometrioma, according to a study that featured in Obstetrical & Gynecological Survey.

Currently, the possible treatments for an endometrioma include:

  • watchful waiting
  • medical therapy
  • surgical intervention
  • inducing ovulation and using assisted reproductive technology in females with infertility

People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include:

  • cefotetan (Cefotan)
  • cefoxitin (Mefoxin)
  • clindamycin (Cleocin)

Some people can receive treatment outside of the hospital setting with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).

In the past, tubo-ovarian abscesses required surgical removal of the uterus, ovaries, and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.

Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes.

People with leiomyomas or fibroids may receive hormonal treatments or nonsteroidal anti-inflammatory drugs to control the symptoms. Once a person stops taking medication, the symptoms may return, and the fibroids may continue to grow. Surgery is the most successful treatment for fibroids.

The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:

  • the type of ovarian cancer and how much cancer is present
  • the stage and grade of the cancer
  • whether the person has a buildup of fluid in the abdomen causing swelling
  • whether surgery can remove the whole tumor
  • genetic changes
  • the person’s age and general health status
  • whether it is a new diagnosis, or if cancer has come back

Risk factors

Risk factors depend on the cause of the adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More than 80% of females with ovarian torsion have masses of 5 cm or larger.

Doctors diagnose fibroids in about 70% of white females and more than 80% of black females by the age of 50 years. Other factors may increase a person’s risk of developing fibroids, such as:

  • starting periods early in life
  • using oral contraceptives before 16 years of age
  • an increase in body mass index (BMI)

Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:

  • inherited genetic changes
  • hereditary nonpolyposis colorectal cancer
  • endometriosis
  • postmenopausal hormonal therapy
  • obesity
  • tall height

The likelihood of developing cancer also tends to increase with age.

Summary

Adnexal masses are lumps that doctors may find in the adnexal of the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous, and they do not all require treatment.

Different types of adnexal mass can share many of the same symptoms. As a result, doctors need to collect a full medical history and data from physical examinations, blood tests, and medical imaging, including transvaginal ultrasounds.

Doctors need to pinpoint the location and cause of an adnexal mass to determine the appropriate management and treatment.

A big stress factor that isn’t usually addressed is pre-menopausal or menopause effect on sleep. If you’re 40 or over, you can agree that insomnia is real! This culprit must be addressed. Many women experience sleep problems before and during menopause when hormone levels and menstrual periods become irregular. Often, poor sleep sticks around throughout the menopausal transition and after menopause.

Hormones shift throughout women’s lives, and changes to estrogen, progesterone and other hormones can lead to recurring sleep problems well before the transition to menopause actively begins. You might think that a good night’s sleep is nothing but it becomes a precious commodity once you reach a certain age.

Hot flashes are sometimes referred to as, “personal summers.’ Any woman in this stage of life will tell you that if feels like your body has turned into an oven. Sleeplessness due to menopause is often associated with hot flashes. These unpleasant sensations of extreme heat can happen during the day or at night. Nighttime hot flashes are often paired with unexpected awakenings.

There are changes in the brain that lead to the hot flash itself, and those changes — not just the feeling of heat — may also be what triggers the awakening.

When they happen at night, hot flashes are called night sweats. Some women find that hot flashes interrupt their daily lives. The earlier in life hot flashes begin, the longer you may experience them. Research has found that black women get hot flashes for more years than white and Asian women.

Lifestyle changes to improve hot flashes
Before considering medication, first try making changes to your lifestyle.
If hot flashes are keeping you up at night, keep your bedroom cooler and try drinking small amounts of cold water before bed. Layer your bedding so it can be adjusted as needed. Some women find a device called a bed fan helpful. Here are some other lifestyle changes suggested by research:
• Dress in layers, which can be removed at the start of a hot flash.
• Carry a portable fan to use when a hot flash strike.
• Avoid alcohol, spicy foods, and caffeine. These can make menopausal symptoms worse.
• If you smoke, try to quit, not only for menopausal symptoms, but for your overall health.
• Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
• Try mind-body practices like yoga or other self-calming techniques. Early-stage research has shown that mindfulness meditation, may help improve menopausal symptoms.

Here is what works for me and my suggestions from a few years of trial/errors, research, doctor’s input, etc:
1. Stop worrying about sleep! Period. It also meant I had to address other areas of my life. Most of what ails us is addressed holistically. As a first born with a type A personality, my default to is to find solutions which means my brain is working constantly. Sometimes, I ponder problems that have not yet been invented. Which also means that I’m not present in the moment. I lived in the future somewhere. However, I’ve learned to pay attention to the Here and Now, and enjoy those in my life circle. I endeavor to Live my best life and not try to fix everything. This helps quiet my mind.
2. It is perfectly okay to give yourself a limited amount of time to ‘stress or fuss’ after which you stop and move on to a mindless activity. Sleep will come.
3. Exercise is my go-to therapy. When I run, I sleep better.
4. Sex is a great precursor to sleep but only after both parties are fully satisfied. If the woman is a passive participant, she’ll have to watch her partner sleep joyfully next to her.
5. I am an avid aromatherapy advocate. We must be consistent in this. It takes a while for your body to acclimate to a particular scent. My scent of choice is lavender because it calms me.
6. I drink chamomile or any relaxing tea at night. This is a staple.
7. I love baths and my doctor suggested I take one before I sleep. I soak in the tub with bath beads, light candle. OR take a shower in the dark but rub your body with aroma oils and inhale.
8. Finally, once in a while, I find my way to my massage therapist, who usually says that my body is knotted up; however after 2 hours or so, I am loose and ready to climb in bed

Uterine fibroids are noncancerous growths that grow in the wall of the uterus. When fibroids cause heavy bleeding or painful symptoms, and other treatments are ineffective, a doctor may recommend surgery.

Fibroids are common, but it is challenging for doctors to determine what percentage of people have them, as not everyone experiences symptoms. According to various estimates, fibroids may affect between 20% and 80% of the female population under the age of 50 years.

Although fibroids can sometimes grow to the size of a grapefruit or even larger, they are often very small. Many people with fibroids are unaware that they have them. People with asymptomatic fibroids do not require surgery or other treatments.

However, other people experience abdominal pain, pressure, bloating, pain during sex, frequent urination, and heavy or painful periods. These individuals may require surgery.

In this article, learn more about surgery for fibroids, including the types, risks, and what to expect.

Types

There are several different surgical approaches to treating fibroids. The types of surgery that a person can have will depend on the location of the fibroid.

A doctor will usually recommend more conservative options, such as medication, before considering surgery.

In cases where medication and other treatments do not work, surgical options include the following:

Myomectomy

Myomectomy is a surgical procedure that removes fibroids. Depending on the location of these growths, a surgeon may also have to remove other tissue in the process. Surgeons offer different myomectomy techniques.

The traditional technique is quite invasive as it uses a relatively large cut. This incision may go from the bellybutton to the bikini line or run horizontally along the bikini line. Some surgeons also perform laparoscopic surgeries, which use smaller incisions but require more skill.

Although a myomectomy preserves the uterus, women who wish to become pregnant should speak to a doctor about the possible complications. Those with very large or deeply embedded fibroids may only be able to have cesarean deliveries after this procedure.

New fibroids may develop after a myomectomy, which means that it is not a permanent solution for everyone.

Radiofrequency ablation procedure

Radiofrequency ablation destroys fibroids using either an electric current, a laser, cold therapy, or ultrasound. It requires only a small incision.

However, it can cause dangerous pregnancy complications, such as scarring and infection, so doctors do not recommend it for those who are planning future pregnancies.

Radiofrequency ablation may be a good option for people considering a hysterectomy who want a less invasive procedure.

Endometrial ablation

Endometrial ablation does not remove fibroids, but it can help relieve heavy bleeding.

During endometrial ablation, a surgeon uses a range of techniques — which may include heat, electric current, freezing, lasers, or wire — to destroy the lining of the uterus. These techniques reduce or stop heavy bleeding.

This procedure is less invasive than some other surgical options. Sometimes, doctors can even perform it on an outpatient basis in their office.

This procedure may prevent women from being able to get pregnant in the future, so it is not a good option for those who would still like to have children.

Fibroid or artery embolization

A doctor can locate the blood vessels that feed into the fibroid and disrupt their blood supply. During this procedure, they will insert a tube into blood vessels that supply the fibroid and then inject tiny particles that block the fibroid’s blood supply. The lack of blood shrinks the fibroids.

Doctors can do this procedure on an inpatient or outpatient basis, and recovery is usually fairly straightforward. Fibroids do not typically grow back after embolization.

While pregnancy is sometimes possible after fibroid embolization, doctors do not know enough about the risks. Therefore, they do not recommend this procedure for women who wish to get pregnant.

Magnetic resonance-guided focused ultrasound surgery

In magnetic resonance-guided focused ultrasound (MRgFUS), a doctor uses an ultrasound to heat and destroy fibroids.

This procedure can target the individual fibroids and avoid affecting the surrounding healthy tissue. A doctor will do an MRI scan to determine whether a person is a suitable candidate for MRgFUS. They may not recommend MRgFUS if the fibroids are too large or too close to any bones or the bowel.

MRgFUS may be a good option for women who plan to get pregnant, as it leaves the uterus intact. However, more data is necessary to confirm its safety for these individuals.

Hysterectomy

A hysterectomy is a surgery to remove the uterus and, sometimes, the ovaries. A hysterectomy permanently eliminates uterine fibroids.

This procedure is not an option for anyone planning a future pregnancy, as it removes the womb. Some people opt to leave the ovaries in place so that they continue producing estrogen.

A surgeon may be able to perform a laparoscopic hysterectomy, which uses several small incisions and a tiny camera to help the surgeon see inside the abdomen. An open hysterectomy requires a large incision between the bellybutton and the bikini line.

Another option is a vaginal hysterectomy, which is the approach that most people prefer. In this procedure, a surgeon will remove the uterus through the vagina.

A vaginal hysterectomy may not be possible if the uterus or fibroid is too large to fit through the vagina.

Individuals who undergo an open hysterectomy may have a longer recovery time. Doctors usually recommend a hysterectomy only for those whose fibroids are very large or significantly interfere with their quality of life.

People who have other reproductive health issues, such as endometriosis, may find that a hysterectomy provides significant relief from fibroids and other symptoms.

Morcellation

Morcellation is a procedure that reduces the size of fibroids so that a surgeon can remove them through a tiny incision in the abdomen. A doctor may use morcellation during a myomectomy, hysterectomy, or other surgery.

However, the Food and Drug Administration (FDA) caution that morcellation carries significant risks.

While fibroids are not cancerous, uterine cancer is more common in people having fibroid surgery than experts previously thought.

It can also be difficult to tell the difference between a fibroid and a type of cancer that looks the same. According to the FDA, morcellation may inadvertently spread cancer that resembles a fibroid.

Is surgery necessary?

Not everyone with fibroids needs treatment. In most cases, there is no reason to treat fibroids that cause no symptoms.

Some people with fibroids can treat symptoms successfully with medication, including hormonal birth control pills. Others alleviate fibroid symptoms by using pain relievers and other management strategies.

Before considering surgery, people can ask a doctor about other treatment options. The doctor should also provide clear details about the risks and benefits of each surgical procedure.

Fibroids can shrink or disappear after menopause, so people nearing menopause whose symptoms are not severe may wish to postpone treatment.

Benefits

The benefits of surgery depend on the type of surgery and can vary from person to person. For example, there is no chance that the fibroids will grow back after a hysterectomy. However, they may regrow following other procedures.

Some potential benefits include:

  • reduced bleeding
  • relief from pain or pressure
  • removal of fibroids
  • the potential that fibroids will either not grow as large or not regrow at all

Risks

Most people who have fibroid removal surgery have no serious complications, but they may experience pain or bleeding following surgery and will need time to recover.

However, a small number of people do face serious complications. The specific complications and their likelihood depend on the type of surgery that a person chooses, but they can include:

  • anesthesia-related risks
  • infections
  • heavy bleeding
  • failed surgery
  • regrowth of fibroids
  • damage to the uterus or other surrounding organs
  • in the case of morcellation, spreading cancer

How does fibroid surgery affect fertility?

The effects of fibroid surgery on fertility depend on the type of surgery. A hysterectomy or endometrial ablation usually makes pregnancy impossible.

Some procedures that may affect fertility but will not necessarily prevent pregnancy include:

  • morcellation
  • embolization
  • radiofrequency ablation

A myomectomy does not typically affect fertility. However, any surgery on the uterus can potentially damage the reproductive organs and affect future pregnancies.

Recovery

Most fibroid removal surgeries require general anesthesia. A person may need to stay overnight in the hospital, so the hospital staff may advise them to bring an overnight bag.

Invasive surgeries, such as a hysterectomy or a nonlaparoscopic myomectomy, typically have the longest recovery time.

A person can try the following to help ease recovery:

  • asking a doctor about the specific recovery timeline for the chosen surgery
  • asking a doctor about laparoscopic procedures and talking to a specialist with experience in minimally invasive surgery
  • following the doctor’s self-care and recovery instructions
  • getting help from a loved one in the days following surgery

Other treatment options

In most cases, a doctor will recommend trying other treatments before pursuing surgery.

Treatments for fibroids include:

  • Birth control pills. Hormonal contraceptives may slow fibroid growth and prevent heavy, painful periods.
  • Pain medication. Prescription and over-the-counter pain relievers may help with fibroid pain, especially period-related fibroid pain.
  • Iron supplements. For people with heavy bleeding that causes anemia, iron supplements may help.
  • Gonadotropin-releasing hormone agonists (GnRH). These drugs may help shrink fibroids. Some doctors recommend them prior to surgery to make fibroid removal easier.

Summary

Surgery can be lifechanging for people whose fibroids interfere with their quality of life, as it can improve many aspects of their health.

All surgeries present some risks, however, so it is vital to explore all treatment options. A doctor can provide advice on which surgeries might be appropriate. A person may also wish to consider seeking a second opinion before agreeing to surgery.

Depression is more than just sadness and can be a serious and potentially life threatening illness. Even very young children can develop depression, so parents and caregivers must take the condition seriously.

According to the Centers for Disease Control and Prevention (CDC), 3.2% of children aged between 3 and 17 in the United StatesTrusted Source have a depression diagnosis. This figure likely underestimates how common depression is among young people.

A 2018 analysis emphasizesTrusted Source that depression is underdiagnosed in children and that just 50% of depressed teens receive a diagnosis before adulthood. The suicide rate has risenTrusted Source over the past 2 decades, including among children.

It is vital to note that the symptoms of depression are also highly treatable, especially when a child has adequate support from loving caregivers.

In this article, learn more about depression in children, including the signs, symptoms, and how to find help.

Signs and symptoms

Children with depression may feel sad or hopeless. Depression, however, is much more than just sadness. It can affect many aspects of a child’s behavior or mood.

Young children may complain of physical symptoms, such as frequent stomachaches, instead of emotional pain. They may also fear separation from their parents, develop behavioral problems, or seem agitated and restless.

Some other symptoms of childhood depression include:

  • loss of interest in activities a child once enjoyed
  • withdrawal
  • low motivation
  • changes in sleeping habits, such as sleeping very little or too much
  • eating habit changes, such as overeating or not eating enough
  • running away
  • having thoughts of or talking about suicide
  • interest in death
  • giving things away
  • feeling hopeless
  • low self-esteem
  • trouble concentrating
  • new or worsening problems at school, with siblings or friends
  • use of alcohol or drugs, especially among teens

Risk factors

Depression is a complex illness with biological, psychological, and social causes. This means that many factors contribute to depression, including:

  • genetics
  • alterations in brain chemistry
  • personality
  • environmental factors, such as trauma and stress

The chance of depression is highest in children who have several risk factors.

Some risk factors for depression in children include:

  • being female when considering teens
  • family history of depression
  • being born to a mother younger than 18 years old
  • history of stress or trauma, including conflict between the child’s parents or caregivers
  • sleep issues
  • medical problems, especially chronic illnesses, such as asthma
  • overweight or obesity
  • lack of coping skills
  • negative thinking style
  • self-consciousness
  • poor relationships with friends
  • school difficulties
  • recent loss, such as changing schools or the death of a loved one
  • low birth weight

There is no way to predict who will or will not experience depression. Some children with many risk factors never develop depression, while others with few or no apparent risk factors do.

Diagnosis

No blood or imaging test can detect depression. Instead, a mental health professional, for example, a psychiatrist, therapist, or social worker, will ask about the child’s symptoms and behavior.

Looking at the child’s symptoms, the doctor will determine whether they have depression, another mental health condition, or both.

Caregivers can help a doctor make a diagnosis by keeping a list of symptoms. They should be prepared to answer questions about the child’s history, when symptoms first appeared, and whether there is a family history of depression.

The provider may want to meet with the child alone because some children, especially teens, may not feel comfortable discussing all of their symptoms in front of others.

Treatment

The treatment for depression may include therapy, medication, lifestyle changes, and family counseling.

Many people need to try several treatment strategies before they find one that works for them. It is helpful to ensure the child receives therapy and comprehensive mental health support in addition to medication or other treatments to ensure they get the best results.

A doctor may recommend:

  • family counseling if there are family problems or a history of trauma
  • education about depression and how best to help
  • antidepressant medications
  • increased activity, since some people get relief from depression with exercise
  • individual therapy to help the child better manage their emotions and stress

Effective treatment should avoid stigmatizing the child or punishing them for behaviors that come from depression.

Supporting a child with depression

Parents and caregivers may worry that they caused the child’s depression or believe that they can cure it with love or discipline. Depression is a complex illness and rarely has one cause.

A loved one cannot cure a child’s depression, just as they cannot cure a physical condition, for example, diabetes. Instead, parents should focus on building a supportive environment in which the child can recover.

People may want to try these strategies:

  • Include the child as an active participant in their treatment. Encourage them to participate in making decisions as much as possible.
  • Ask the child about any side effects of their medication and work with them to find treatments that are effective.
  • Encourage the child to talk about their feelings and listen without judgment. Do not tell the child how they should feel.
  • Create a home life that is as stable and secure as possible. Minimize conflict between adults and other family members, and work to help the child manage recent traumas.
  • Educate other family members about depression so that they can offer support and help.

Related conditions

Parents sometimes mistakenly believe that any sign of mental distress in children means the child has depression.

Pediatricians and other doctors may even miss the signs of other mental health conditions. In some cases, symptoms of one disorder may mimic those of depression. For example, a child with attention deficit hyperactivity disorder (ADHD) who struggles at school may appear to be feeling hopeless and sad.

Some other conditions that may have similar symptoms to depression in children include:

Certain mental health and behavioral conditions commonly co-occur with depression. According to the CDCTrusted Source, 73.8% of children with depression also have anxiety, while 47.2% also experience behavior problems.

Summary

Children with depression need support and care. Caregivers should remember that the issue is medical in nature, and it is not something that can resolve with discipline.

Very young children may lack the ability to communicate their emotions. On the other hand, older children may feel embarrassed or worry about getting into trouble.

Adults can help children get the right treatment while reassuring them that depression is treatable and not a personal failing. A pediatric mental health expert can be a valuable resource for the entire family.

Insomnia can have a serious impact on a person’s health and well-being. Now, a study of females aged 50 and over has found that some parts of the diet most likely contribute to this sleep disorder.

Insomnia affects many people all over the world. According to the National Sleep Foundation, up to 40% of people in the United States experience some insomnia symptoms each year.

Researchers have taken due note of this, as numerous studies have suggested that insomnia is not just a mild annoyance: It may actually be linked with many other negative health outcomes.

According to the Centers for Disease Control and Prevention (CDC), short sleep duration and sleep disruptions are associated withTrusted Source cardiovascular problems, diabetes, and depression, to name a few.

For this reason, specialists have been looking for ways of preventing or treating insomnia and other sleep disorders — starting by looking for all the possible causes.

Existing research has already called attention to the fact that diet may influence a person’s sleep qualityTrusted Source. Now, a study from Columbia University Vagelos College of Physicians and Surgeons in New York City, NY, suggests that a diet high in refined carbohydrates — particularly added sugars — is linked to a higher risk of insomnia. This, at least, appears to be the case among females aged 50 and over.

The research team reports these findings in a study paper that now appears in The American Journal of Clinical NutritionTrusted Source.

“Insomnia is often treated with cognitive behavioural therapy or medications, but these can be expensive or carry side effects,” explains senior study author James Gangwisch, PhD.

But, he adds, “[b]y identifying other factors that lead to insomnia, we may find straightforward and low cost interventions with fewer potential side effects.”

The possible underlying mechanism

The researchers worked with the data of 53,069 female participants aged 50–79, all of whom had enrolled in the Women’s Health Initiative Observational Study between September 1994 and December 1998.

To understand whether or not there really is a link between dietary choices and the risk of insomnia, the investigators looked for any associations between different diets and sleep disruptions.

Gangwisch and colleagues found a link between a higher risk of insomnia and a diet rich in refined carbohydrates. This includes foods with added sugars, soda, white rice, and white bread.

The researchers caution that it was unclear from their analysis whether the consumption of refined carbohydrates led to insomnia, or that people who experienced insomnia were more likely to consume refined carbs, especially sugary foods.

However, they do note that there is a possible underlying mechanism that might explain added sugars causing sleep disruptions.

“When blood sugar is raised quickly, your body reacts by releasing insulin, and the resulting drop in blood sugar can lead to the release of hormones such as adrenaline and cortisol, which can interfere with sleep,” Gangwisch explains.

Why fruit will not impact sleep

The study authors also explain why not all foods that contain sugar will lead to the same effect. Fruits and vegetables — which naturally contain sugar — are unlikely to raise blood sugar levels nearly as quickly as foods containing added sugars.

This is because these natural foods are also high in fiber, which means that the body absorbs the sugar more slowly, preventing a spike in blood sugar levels.

Indeed, the female participants who had diets rich in vegetables and whole fruits — but not fruit juices — did not have an increased risk of insomnia.

“Whole fruits contain sugar, but the fiber in them slow the rate of absorption to help prevent spikes in blood sugar,” says Gangwisch.

“This suggests that the dietary culprit triggering the women’s insomnia was the highly processed foods that contain larger amounts of refined sugars that aren’t found naturally in food.”

James Gangwisch, Ph.D.

The researchers only worked with females aged 50 and over, but they believe that the findings could also apply to males and people of other ages. Going forward, they argue that this idea is worth exploring in more detailed studies.

“Based on our findings, we would need randomized clinical trials to determine if a dietary intervention, focused on increasing the consumption of whole foods and complex carbohydrates, could be used to prevent and treat insomnia,” concludes Gangwisch.

Depression is a widespread mental health condition. Pregnant women have a higher risk of depression due to increased stress, physical health changes, chemical changes in the body, and other factors.

While estimates vary, a 2016 analysisTrusted Source suggests that between 7% and upwards of 20% of pregnant women around the world have depression. The actual rate could be higher, since some women may be reluctant to seek help.

Depression during pregnancy can have emotional, health, relationship, and financial effects. Some people know this condition as prenatal depression. However, the American Psychiatric Association no longer use this term. Instead, they use the term major depressive disorder with peripartum onset.

Depression during pregnancy is treatable.

In this article, learn more about the symptoms of depression during pregnancy, as well as the treatment options and when to see a doctor.

Signs and symptoms

It is normal to feel a mix of emotions during pregnancy and about being pregnant.

While a person with depression may feel sad, sadness is just one of many depression symptoms.

Some other signs include:

  • new or worsening feelings of worthlessness or hopelessness
  • not enjoying activities that were once fun or meaningful
  • withdrawing from friends, family, school, work, or hobbies
  • new physical health symptoms, such as headaches or stomach aches
  • trouble feeling excited about the pregnancy or bonding with the baby after childbirth
  • feelings of isolation and low self-esteem
  • trouble sleeping
  • sleeping too much
  • changes in eating habits, such as eating more or less than usual
  • thoughts of death or suicide
  • frequent crying
  • unexplained anger
  • relationship stress
  • difficulty following prenatal health recommendations because of feelings of helplessness or hopelessness

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.

Risk factors

Anyone can become depressed during pregnancy, though some people are more vulnerable.

The authors of a 2017 analysisTrusted Source reviewed 5 years of previous studies on the topic and identified the following risk factors:

  • previous history of depression
  • little or no exercise
  • not having a partner
  • a history of abuse or trauma
  • abuse by a partner
  • feeling out of control
  • smoking
  • using certain drugs, such as opioids
  • sleep problems
  • immune system problems
  • having an unintended pregnancy
  • not having a job

Effects on pregnancy

Many women who experience depression during pregnancy have healthy pregnancies. Depression does not mean the baby will be unhealthy or make any particular pregnancy outcome inevitable.

However, research suggestsTrusted Source that depression during pregnancy may raise the risk of:

  • postpartum depression
  • depression in the baby’s father
  • premature birth
  • low birth weight
  • behavior problems or a difficult temperament in the baby
  • changes in the baby’s brain development

2011 studyTrusted Source emphasizes that untreated depression increases the risk of adverse pregnancy outcomes. Prompt treatment can improve the outcomes for both the pregnant woman and the developing fetus.

Treatments

Many people find that they must try several treatments or a combination of treatments to get relief from depression symptoms.

Some treatment options that may work include:

  • antidepressants to manage the chemical changes in the brain that depression causes
  • therapy to help the pregnant woman talk through emotions, identify coping skills, and getting support for the challenges of pregnancy
  • support from friends and family
  • family or relationship counseling to help expectant people talk about their emotions and manage the challenges of parenting
  • lifestyle changes, such as doing more exercise, as long as it is safe during pregnancy
  • support groups for expectant parents
  • treatment for any underlying medical conditions

Are antidepressants safe during pregnancy?

handful of studiesTrusted Source link antidepressant use during pregnancy to an increased risk of congenital disabilities. Some studies have also found an increased risk of premature birth and low birth weight.

However, many studies fail to control for other factors that might explain these outcomes, such as worse health in women with depression or the effects of depression itself on the pregnancy. Additionally, some of the research is contradictory and inconclusive. The side effects are not consistent across studiesTrusted Source.

The risks of untreated depression may outweigh any potential risks of antidepressants. Research has found that 60–70%Trusted Source of women who stop using antidepressants during pregnancy experience a return of depression symptoms.

The American College of Obstetricians and Gynecologists advise that the risk of side effects from antidepressants during pregnancy is low. The risk, they add, is highest in very early pregnancy—during the 3rd to 8th weeks.

Antidepressants are not the only treatment for depression during pregnancy, however. Therapy, lifestyle changes, support from friends and family, and sometimes family or couples counseling are also good options. Most people use a combination of treatments.

Some pregnant women prefer to try other treatments before choosing antidepressants. This strategy may work for some people, but not others.

When to see a doctor

Anyone who is pregnant and suspects they have depression should see their doctor as soon as possible. Most obstetricians and midwives have basic training in detecting depression in pregnant women.

They can also help a person decide on the right treatments and answer any questions they have about potential risks to the baby.

To get quality, comprehensive treatment, most people need additional support from a mental health professional.

A psychiatrist can help with deciding on the right medication, assessing the risk of side effects, and switching medications if necessary. A therapist, psychologist, or clinical social worker can also offer therapy and may recommend lifestyle or other changes to improve symptoms.

Summary

Depression during pregnancy can be an isolating experience. Friends and family may have unfair expectations that pregnant women always feel happy and fail to recognize the many challenges associated with pregnancy and parenthood.

Some women feel guilty or ashamed of their emotions or worry that depression means they are unfit for parenthood.

Depression is no one’s fault. It is a treatable medical condition. The hopelessness that comes with depression may convince a person that treatment will not work, or that they will feel miserable forever. These feelings are symptoms of depression, not a reasonable assessment.

Prompt treatment is vital to relieve symptoms and to help a woman have a healthy and content pregnancy.

“I used to be a full-time patient at this facility,” says Michelle Eze, a drug abuse survivor, as she signs her name in the register for a check-up with her psychiatrist at Karu General Hospital in Abuja, Nigeria’s Federal Capital Territory(FCT).

“I’m so glad I sought help in time as I was dependent on drugs and it cost me so much. It negatively affected the relationship with my family and people around me. I was disowned and left to face this harsh world all by myself. Drug abuse is a problem we should all join hands and fight it.”

Michelle is now a full-time ambassador against drug abuse among women.

One out of every four people who uses drugs in Nigeria is a woman, according to a 2018 report by the United Nations Office on Drugs and Crime (UNODC).

Over 300,000 Nigerians are high-risk drug users

Approximately 376 000 people – or about 0.4% of the Nigerian population aged 15-64 – are reckoned to be high-risk drug users, according to the UNODC report. Nearly 90% of these users regularly take opioids – particularly pharmaceutical opioids such as tramadol codeine, or morphine – while the others take cocaine or amphetamines.

Over 20% of the high-risk drug users inject drugs, with women first injecting on average at 20 years old and men first injecting on average at around 21 years old. HIV prevalence among women who inject drugs is almost seven times higher than among men who inject, according to the 2010 National Agency for the Control of AIDS (NACA) Integrated Biological and Behavioural Surveillance survey.

“At Karu hospital, we receive roughly 15 patients every day and usually at least half of them report to be using one drug or another,” says Pius Wabass, a psychiatric nurse on the Karu General Hospital’s psychiatry ward.

“These patients are often so young – under 40 – and, of late, more women are checking into our facility. The misuse of drugs

has serious health repercussions. Medically, opioids are primarily used for pain relief, including anaesthesia, while amphetamines are powerful stimulators of the central nervous system used to treat some medical conditions.”

Efforts to respond to drug use in Nigeria

As countries including Nigeria make efforts to respond to drug use among the population, health experts note that there are some factors that affect women more than men. A lot of factors have been identified as putting women at increased risk, some are psychological, cultural, social and economic aspects of their lives. Another issue is the general perception that drug use is a male issue and women users are often reluctant to seek help. The Federal Ministry of Health (FMOH) is now addressing this.

“The FMoH has taken up this challenge and currently working with all stakeholders to respond to drug use among young people, especially women,” explains Dr Jimoh Salaudeen from the Food and Drug Division, FMOH. As part of the response, a women-specific drug treatment programme has been established at the federal neuropsychiatric hospital in Kware in Sokoto State and the ministry hopes to replicate such centres across the country.”

Dr Salaudeen continues: “There is a strong linkage between opioid use disorders and health conditions such as preterm births, stillbirths, poor foetal growth, maternal death and neonatal abstinence syndrome. This is why the Ministry of Health has prioritized sexual reproductive health, particularly for women, within the context of drug treatment and harm reduction.”

Working assiduously to reduce drug demand and harm in Nigeria

The FMOH, with the support of WHO, established the National Technical Working Group (NTWG) on drug demand and harm reduction in Nigeria in May 2019.

“The NTWG is working under the leadership of the Minister of Health and is actively engaged in implementing a comprehensive public health response to the challenge of drug use in the country,” says Dr Rex Mpazanje, WHO Cluster Coordinator for Communicable and Non Communicable Diseases.Close

“This effort also includes bringing together different stakeholders at the national and state level for a concerted response. This includes advocacy, capacity building and resource mobilization to ensure promotion of evidence-based prevention activities and the availability of drug treatment and harm reduction programmes at community level.”

Target 3.5 of the United Nations 2030 Sustainable Development Goals (SDGs) is to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. WHO Nigeria will continue to support to the Government of Nigeria in achieving this goal.

The behavioural medicine unit of the Karu General Hospital, Abuja. Many drug abuse patients are treated here.

As the world marks the 2019 World Aids Day today, stigmatisation and discrimination against Persons Living With HIV/AIDS (PLWHAs) remain the twin factors frustrating a successful fight against the dreaded scourge.

Not only have they prevented people from coming forward to know their status and consequently commence early treatment where result turns out positive, these factors also pose a threat to meeting the 2030 global target to end AIDS.

For PLWHAs, the constant psychological trauma they contend with at treatment centres and in communities where they live further makes life difficult. In fact, the reality of living with a life-threatening ailment finds expression daily in the discriminating and stigmatising behaviours directed at them within their environment.

For instance, “You this dead woman, a living corpse, leave my house!” was how Funmi Okafor, a mother of four children was welcomed as she returned home from the hospital after receiving the news that she tested positive to Human Immunodeficiency Virus (HIV), after weeks of constant sickness that defied treatment.

Okafor, who was squatting with a friend, (alongside her kids) after the death of her husband, met her belongings outside, drenched in rainwater, while her friend stood by the door post yelling at her to move away with her children.

With nowhere else to put up, she was forced to move into an incomplete building as her new home.

The mother of four’s journey to this sad realisation started when she noticed rashes on her body, while she was constantly ill and began to lose weight in the process.

With the constant illness, which she thought was malaria fever (as many people would think first), she, however, decided to visit a nurse, whom she told about her constant “malaria fever.”

The nurse took her blood sample to the laboratory to carry out malaria, typhoid, and HIV tests. And on confirming the cause of Okafor’s ailment, the nurse, due to lack of knowledge about patient’s right to confidentiality, refused to inform Okafor that she tested positive to HIV, but rather spread the news around the community where she lived in Edo state.

Determined to know the ailment that has caused her to emaciate, with rashes all over her body, Okafor visited a general hospital, where after the test she was pronounced HIV positive.

“I went to a nurse and told her that I had malaria fever. She took my blood sample to the laboratory. But instead of her disclosing my condition to me, she told my friend, who spread the rumour around. I still was not aware of my status because she did not disclose it to me. It was only after I went to the general hospital that I knew my condition.

“The day I was supposed to be placed on drugs, it rained heavily, and by the time I returned to where I squatted with my children, my host had thrown out all my belongings. After yelling at me and calling me names, I packed what was left of my property and moved,” she recalled.

Before long, Okafor became the butt of jokes in the community where she lived in Edo State, and others avoided contact or any relationship with her. Since she could not stand being ostracised like that, she relocated to Lagos with her children.

She lamented: “It is not easy to cope with life when you are HIV positive. My father and husband are late, while my mother and siblings are in the village. But I was almost alone in the world before I relocated to Lagos because everyone started deserting me,” she said.

CHINWE IKE was pregnant when she discovered that she was HIV positive. She felt like taking her life and for several nights thoughts of suicide assailed her, especially because she did not know what the virus was all about, as people kept saying different things about it.

At the early stage of her pregnancy in 2006, she was on admission to a hospital for one week before she was transferred to another hospital for further treatment.

However, when she went into labour, her HIV status was confirmed in a private hospital, and the doctor in charge of the case requested that she invited a trusted relative over, who would thereafter break the news to her in a calm manner, and get her to accept her condition.

“I decided to invite my friend, who is a nurse instead of a relative. Unfortunately, after she heard of my condition, she went about scandalising me to the extent that my landlady came to me one day and asked me to leave her house. It was afterward that I discovered that it was that my nurse friend that fed everyone with details of my HIV status. Since my landlady insisted that I should leave her apartment, I did,” she said.

Ike added that it was after she left the compound before she started understanding many things about the disease, her rights as a Person Living With HIV (PLWHA). “Just because I did not know anything I had to leave the compound because they were threatening to kill me. Since then I have been living with that stigma and picking up the pieces of my life.

“It is 13 years now and I am still alive. My friend told me then that I had dug my grave, but after some years, I went back to my former neighbourhood for them to see that I am still alive, and when they saw me, most of them were surprised. However, because of the scandal, I lost my job as a secretary/cashier at a company located at the Alaba International Market, Lagos.”

Since 2001 that Chika Nnoroka discovered that she and her 18-month-old son were HIV positive, she has faced extreme stigmatisation and discrimination, not only in her community but also at medical facilities.

She narrated, “The stigmatisation and discrimination got so intense that I did not believe that I and my son would survive. People were keeping away from us, even the doctors and nurses were all stigmatising people living with HIV to the extent that most of us were finding it difficult to go to the facility to access treatment.”

Nnoroka said women were more vulnerable to HIV/AIDS stigmatisation, as many that have lost their husbands were being denied by their family members and friends. Their rights and privileges are also denied.

“By the time I got information from the doctor that there was a treatment to suppress the virus, I was a little bit relieved, but I was afraid for my little son, who just came into this world. I was not bothered about myself,” she said.

Chika’s son, who is now a 20-year-old, is waxing strong with the help of the drugs.

Misconceptions On Mode Of Transmission
Okafor, who has lived with the virus for 19 years said, “most people think that all women living with HIV are prostitutes. My husband was the one that deflowered me; you can contract HIV/AIDS from anywhere.

“I want people to change the narrative that ladies living with HIV/AIDS are wayward, I believe that is why people do not want to come out to check their status or speak up that they have the virus.”

Okafor who narrated how she contracted the virus said, “It was late but the symptoms in my husband’s body showed that he had HIV and he lied to me that it was severe cough. His close friend was the one who disclosed to me that my husband was HIV positive and that his family is keeping it away from me. He said I should go and check myself if I also have the virus.

“I did my test and found out that I was positive. My husband was never a womaniser; I suspect he contracted HIV when he was stabbed him in the chest. He had internal bleeding in his lungs and the hospital asked us to get nine pints of blood, this was during the early 1980s. I strongly believe that it was then that he contracted the disease.”

Ike on her part said: “I am somebody that does not flirt around, I contracted HIV through my husband. It was when I got married to him that I discovered that I had the virus. Initially, I could not believe that I was down with that kind of health problem.”

According to the World Health Organisation (WHO), HIV can be transmitted through close contact with specific body fluids of persons living with the virus. Apart from fluids such as blood, semen, and breast milk; unprotected sex, body piercing equipment, or sharp objects are also vehicles of transmission. Transmission can also be done through mother-to-baby during pregnancy and through contaminated blood transfusion.

‘Cost’ Of Drugs Limiting Access To Treatment
With many of the people living with the virus jobless, and without hope of employment, affording the drugs for treatment and other medical procedures becomes difficult.

Ike said: “These drugs that we are taking are to sustain our lives and we have to eat well before taking them. What I am emphasising on is that the government should help us because right now, we are paying for drugs, and not everyone can afford it. We pay N2, 000 for consultation; N1, 000 for drugs and almost N3, 000 for laboratory. Not everybody that is HIV positive can afford it, so we are begging the government to help people living with HIV, by making drugs and treatment procedures free. It is laughable when we are told that the drugs are free of charge, and when we get to the hospital we are told to pay for the procedures that I have mentioned.

Implications
Findings by The Guardian reveal that because of rising stigmatisation, many people living with HIV/AIDS are staying away from hospitals, while those who suspect their status do not make themselves available for examination. Because of all these, and the inability of many to access treatment early, more people are getting infected and dying from the virus.

This is also why some cases have remained undetected, a development that poses more danger to the country, as those who are unaware of their status could infect others, thereby increasing the spread of the virus.

Ike, who revealed an earlier encounter, which nearly ended her life said: “When I went to a laboratory to do another test to confirm my status, the lab scientists told me that people with the virus can neither get married nor have children. With that impression, I refused to go to the hospital or any other institution for treatment. I concluded that I would commit suicide at home one day.”

Ike who lost her husband to the virus continued: “Because of this stigmatisation people find it difficult to disclose their HIV status because once they do, the news spreads so fast and then sooner than later they are shut out of their families and the society. Where I reside now, I have kept my HIV status a big secret.

“Some people do not even believe that there is something like a discordant couple, where either of the partners is negative, while the other is positive. The reality is that when two people are dating and then one discloses his or her HIV status to the other, the relationship breaks up immediately because they do not believe that those who are positive can have children who are HIV negative,” she explained.

Ike added that her refusal to take treatment cost her two-month-old her life after she developed cough and died. This made her summon courage and head to head to the hospital for treatment.