Thursday, February 20, 2020
Stress

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

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.

A recent review and meta-analysis have investigated whether a plant pigment called quercetin could reduce the risk of cardiovascular disease. In particular, the authors identified that quercetin reduced blood pressure.

Chopped red onion
A compound that occurs naturally in a range of fruits and vegetables, including red onion, may help reduce blood pressure.

Globally, cardiovascular disease is responsible for about 17.3 million deaths each year. As the population’s average age increases, experts expect cardiovascular disease to rise in step.

Researchers have identified a range of lifestyle factors that increase the risk of cardiovascular disease, such as poor diet, low physical activity, smoking, and consuming alcohol. Certain biological markers, including high blood pressure, raised serum lipids, and high blood glucose levels, also predict cardiovascular disease.

Although lifestyle and medical interventions benefit most individuals, they do not work for everyone. For this reason, some researchers are focused on identifying novel ways to reduce cardiovascular risk.

Introducing quercetin

Researchers from Dongguan Shilong People’s Hospital of Southern Medical University in China are interested in quercetin. Quercetin is a flavonoid that naturally occurs in a range of foods, including vegetables, fruits, wine, nuts, red onions, kale, and black tea.

According to the authors of the recent review, “Accumulating evidence indicates that quercetin possesses protective anti-inflammatory as well as antioxidant effects and may be useful in treating a myriad of chronic conditions.”

However, despite some encouraging results, human studies — rather than animal studies or experiments on tissues — have produced inconsistent results. To date, researchers have carried out few meta-analyses to examine the pooled findings of these studies.

To address this issue, the authors of the current paper analyzed studies that investigated quercetin’s influence over a range of cardiovascular risk factors, including blood pressure, lipid profiles, and glucose levels. They published their findings in the journal Nutrition Reviews.

Reanalyzing recent studies

In their analysis, the scientists only included research papers that met certain criteria. All of the studies were randomized placebo-controlled clinical trials that had investigated the effect of quercetin for 2 weeks or more and had involved adults.

The scientists identified 17 relevant papers, which involved a total of 896 participants. The studies took place in six countries: Iran, United States, United Kingdom, Germany, Italy, and Korea.

Overall, they identified no significant effect of quercetin on glucose levels or lipid profiles. However, when they only analyzed data from trials that used a parallel design and lasted 8 weeks or longer, quercetin did appear to improve levels of high-density lipoprotein (HDL or “good”) cholesterol and triglycerides.

A study with a parallel design is one in which researchers compare two or more treatments; for instance, comparing the effects of quercetin against those of a control.

The greatest benefit of quercetin, however, was its effect on blood pressure. The findings showed that quercetin lowered both systolic and diastolic blood pressure. The authors write:

“The main conclusion was that dietary intake of quercetin significantly lowered [blood pressure].”

Benefits for blood pressure

Systolic blood pressure is the pressure in the arteries as the heart contracts, and diastolic blood pressure is the blood pressure when the heart is resting between beats. As an example, if someone’s blood pressure is 120/80 millimeters of mercury (mm Hg), the first number refers to systolic pressure, and the second number denotes diastolic pressure.

On average, quercetin reduced systolic blood pressure by 3.09 mm Hg and diastolic blood pressure by 2.86 mm Hg.

The authors explain that “a reduction in [blood pressure] of more than 10 mm Hg lowers cardiovascular risk by 50% for heart failure, by 35–40% for stroke, and by approximately 20–25% for myocardial infarction.”

The authors believe that “[t]he favorable effects of quercetin on [blood pressure] found in the current investigation support the use of quercetin as an adjunctive therapy in patients with hypertension.”

In other words, quercetin might enhance the benefits of taking hypertension medication and making lifestyle changes, thus helping reduce cardiovascular risk.

Limitations and holes

As the authors explain, the results are not yet conclusive, and many questions remain. They note that the changes in blood pressure varied depending on the type of quercetin formulation and how long the trials lasted.

The authors also noticed substantial differences among the findings of the studies. These differences might be, in part, due to the size of the trials in the analysis: Four of the 17 trials included fewer than 30 participants.

There were also differences in the design of the studies and the age, sex, and body mass index (BMI) of the participants. These differences make it difficult to generalize and compare among experiments.

Overall, the results are promising, but scientists need to conduct larger, longer-term clinical trials before they can confirm the full benefits of quercetin. If the compound eventually proves to reduce cardiovascular risk, it could benefit vast swathes of the population.

A new trial suggests that people who eat walnuts every day may have better gut health and a lower risk of heart disease.

Nuts can be a great source of nutrients and a very healthful “pick-me-up” snack.

Walnuts, in particular, are high in protein, fat, and they are also a source of calcium and iron.

Given walnuts’ nutritional potential, some researchers have been looking at whether these nuts might actually help prevent specific health issues.

In 2019, researchers from Pennsylvania State University in State College found that individuals who replaced saturated fats with walnuts — a source of unsaturated fats — experienced cardiovascular benefits, particularly improvements in blood pressure.

The investigators explain that walnuts contain alpha-linolenic acid, which is a type of omega-3 fatty acid that is present in plants.

Following up from that research, the team — which includes assistant research professor Kristina Petersen and Prof. Penny Kris-Etherton — have recently conducted another study to find out more about walnuts’ benefits to health.

The new study — whose findings appear in the Journal of Nutrition — suggests that incorporating walnuts into a healthful diet may benefit the gut and thus lead to better heart health.

“There’s a lot of work being done on gut health and how it affects overall health,” notes Prof. Kris-Etherton.

“So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease,” she says.

‘A small change to improve your diet’

The researchers conducted a randomized, controlled trial involving 42 participants with overweight or obesity aged 30–65.

They wanted to see if — and how — adding walnuts to a person’s diet might influence gut health.

To begin with, the research team asked the participants to follow a standard Western diet for 2 weeks.

Then, at the end of this period, the researchers randomly split the study participants into three groups. One group followed a diet that included whole walnuts, the second group ate a diet that included alpha-linolenic acid but in the same quantity that the walnuts would contain. The third group followed a walnut-free diet in which the researchers replaced alpha-linolenic acid with oleic acid.

The participants followed their assigned diet for 6 weeks and then switched diets until each person had followed all three eating plans.

The researchers collected fecal samples from all participants at the end of each diet regimen period. This allowed them to analyze any changes regarding the bacterial populations present in the gastrointestinal tract.

Prof. Kris-Etherton, Petersen, and their colleagues found that individuals who ate 3 ounces (oz) of walnuts as part of an otherwise healthful diet experienced improvements in heart health. The scientists say that these changes were likely mediated by improvements in gut health, as suggested by changes in gut bacteria.

“The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” explains Petersen.

“One of those is Roseburia, which has been associated with protection of the gut lining,” she adds. “We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers explain that E. eligens has associations with a variety of different aspects of irregular blood pressure. They add that an increase in the population of this bacterium may thus suggest a lower cardiovascular risk.

They also note that an increase in Lachnospiraceae has links with lower blood pressure, total cholesterol, and “bad” cholesterol measurements.

The study did not find any significant associations between any changes in gut bacteria following the walnut-free diets and risk factors for heart disease.

“Replacing your usual snack — especially if it’s an unhealthful snack — with walnuts is a small change you can make to improve your diet,” notes Petersen.

“Substantial evidence shows that small improvements in diet greatly benefit health. Eating 2 to 3 oz of walnuts a day as part of a healthful diet could be a good way to improve gut health and reduce the risk of heart disease.”

– Kristina Petersen

Just how healthful are walnuts?

The authors of the current study explain that walnuts may bring different health benefits due to the variety of nutrients that they contain.

Co-author Regina Lamendella, who is an associate professor of Biology, emphasizes that “[f]oods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber, and bioactive compounds — for our gut microbiomes to feed on.”

She continues, “this can help generate beneficial metabolites and other products for our bodies.”

Going forward, the research team wants to find out whether whole walnuts might influence other measurements that determine a person’s health, too.

“The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels,” says Prof. Kris-Etherton.

Yet, while nutritious and healthful, do walnuts really have a significant impact on our well-being? The researchers who conducted this study suggest they might.

However, they do disclose that their trial received some funding from the California Walnut Commission, which represents the walnut growers of California. As other research suggests, studies funded by stakeholders often raise issues about trust among the general public.

Other researchers have also concluded that walnuts are “optimal healthful foods.” There are few reports of health risks associated with walnuts for people who do not have a nut allergy or gastrointestinal problems.

For now, the research into how much of a difference walnuts can make for a person’s health continues.

Two recent but separate studies have demonstrated how bitter melon and turmeric could be used to prevent, treat and reduce the progression of cancers.

Commonly called bitter melon, bitter gourd, African cucumber or balsam pear, Momordica charantia belongs to the plant family Cucurbitaceae. In Nigeria, bitter melon is called ndakdi in Dera; dagdaggi in Fula-Fulfulde; hashinashiap in Goemai; daddagu in Hausa; iliahia in Igala; akban ndene in Igbo (Ibuzo in Delta State); dagdagoo in Kanuri; akara aj, ejinrin nla, ejinrin weeri, ejirin-weewe or igbole aja in Yoruba.

Turmeric is a spice that comes from the root of Curcuma longa, a member of the ginger family, Zingaberaceae. In traditional medicine, turmeric has been used for its medicinal properties for various indications and through different routes of administration, including topically, orally, and by inhalation.

In Nigeria, it is called atale pupa in Yoruba; gangamau in Hausa; nwandumo in Ebonyi; ohu boboch in Enugu (Nkanu East); gigir in Tiv; magina in Kaduna; turi in Niger State; onjonigho in Cross River (Meo tribe).

Turmeric, also known as curcuma, produces a root that is used to produce the vibrant yellow spice used as a culinary spice so often used in curry dishes. Though native to India and parts of Asia, and is a relative of cardamom and ginger, turmeric has been domesticated in Nigeria. In Asia, turmeric is used to treat many health conditions and it has anti-inflammatory, antioxidant, and perhaps even anticancer properties.

Meanwhile, Prof. Ratna Ray from Saint Louis University in Missouri, United States (U.S.), and her colleagues, in a recent study on bitter melon, made an intriguing find. In experiments using mouse models, bitter melon extract appeared to be effective in preventing cancer tumours from growing and spreading.

The researchers report their findings in a study paper that now appears in the journal Cell Communication and Signaling. Ray grew up in India, so she was familiar not just with the culinary qualities of bitter melon, but also with its alleged medicinal properties.

This made her curious as to whether or not the plant also harbored properties that would make it an effective aid to anticancer treatments. She and her colleagues decided to put this to the test in a preliminary study by using bitter melon extract on various types of cancer cells — including breast, prostate, and head and neck cancer cells.

Laboratory tests showed that the extract stopped those cells from replicating, suggesting that it might be effective in preventing the spread of cancer. In further experiments using mouse models, the researchers found that the plant extract was able to reduce the incidence of tongue cancer.

So, in their new study, Prof. Ray and team tried to find out what might give bitter melon compounds an edge against cancer cells. This time, they used mouse models to study the mechanism through which bitter melon extract interacted with tumors of cancer of the mouth and tongue.

They saw that the extract interacted with molecules that allow glucose (simple sugar) and fat to travel around the body, in some cases “feeding” cancer cells and allowing them to thrive.

By interfering with those pathways, the bitter melon extract essentially stopped cancer tumors from growing, and it even led to the death of some of the cancer cells. Ray said: “All animal model studies that we’ve conducted are giving us similar results, an approximately 50 per cent reduction in tumor growth.”

Ray and colleagues explained that it remains unclear whether or not bitter melon would have the same effect in humans, but Prof., going forward, this is what they are aiming to find out.

“Our next step is to conduct a pilot study in [people with cancer] to see if bitter melon has clinical benefits and is a promising additional therapy to current treatments,” she noted.

Ray seemed convinced that the plant is, if nothing else, at least a positive contributor to personal health.“Some people take an apple a day, and I’d eat a bitter melon a day. I enjoy the taste,” she said.“Natural products play a critical role in the discovery and development of numerous drugs for the treatment of various types of deadly diseases, including cancer. Therefore, the use of natural products as preventive medicine is becoming increasingly important.”

Meanwhile, a recent literature review investigated whether turmeric may be useful for treating cancer. The authors concluded that it might be but noted that there are many challenges to overcome before it makes it to the clinic. The chemical in turmeric that most interests medical researchers is a polyphenol called diferuloylmethane, which is more commonly called curcumin. Most of the research into turmeric’s potential powers has focused on this chemical.

Over the years, researchers have pitted curcumin against a number of symptoms and conditions, including inflammation, metabolic syndrome, arthritis, liver disease, obesity, and neurodegenerative diseases, with varying levels of success.
Above all, though, scientists have focused on cancer. According to the authors of the recent review, of the 12,595 papers that researchers published on curcumin between 1924 and 2018, 37 per cent focus on cancer.

In the current review, which features in the journal Nutrients, the authors mainly focused on cell signaling pathways that play a role in cancer’s growth and development and how turmeric might influence them. Treatment for cancer has improved vastly over recent decades, but there is still a long path to tread before we can beat cancer. As the authors note, “the search for innovative and more effective drugs” is still vital work.

In their review, the scientists paid particular attention to research involving breast cancer, lung cancer, cancers of the blood, and cancers of the digestive system. The authors concluded: “Curcumin represents a promising candidate as an effective anticancer drug to be used alone or in combination with other drugs.”

According to the review, curcumin can influence a wide range of molecules that play a role in cancer, including transcription factors, which are vital for Deoxy ribonucleic Acid (DNA)/genetic material replication; growth factors; cytokines, which are important for cell signaling; and apoptotic proteins, which help control cell death.

Alongside the discussions surrounding curcumin’s molecular influence over cancer pathways, the authors also addressed the possible issues with using curcumin as a drug. For instance, they explain that if a person takes curcumin orally — in a turmeric latte, for example — the body rapidly breaks it down into metabolites. As a result, any active ingredients are unlikely to reach the site of a tumour.

With this in mind, some researchers are trying to design ways of delivering curcumin into the body and protecting it from undergoing metabolisation. For instance, researchers who encapsulated the chemical within a protein nanoparticle noted promising results in the laboratory and in rats.

Although scientists have published a great many papers on curcumin and cancer, there is a need for more work. Many of the studies in the current review are in vitro studies, which means that the researchers conducted them in laboratories using cells or tissues. Although this type of research is vital for understanding which interventions may or may not influence cancer, not all in vitro studies translate to humans.

Relatively few studies have tested turmeric’s or curcumin’s anticancer properties in humans, and the human studies that have taken place have been small-scale. However, aside from the difficulties and limited data, curcumin still has potential as an anticancer treatment.

Scientists are continuing to work on the problem. For instance, the authors mention two clinical trials that are underway, both of which aim to “evaluate the therapeutic effect of curcumin on the development of primary and metastatic breast cancer, as well as to estimate the risk of adverse events.”

They also refer to other ongoing studies in humans that are evaluating curcumin as a treatment for prostate cancer, cervical cancer, and lung nodules, among other diseases. The authors believe that curcumin belongs to “the most promising group of bioactive natural compounds, especially in the treatment of several cancer types.”

However, their praise for curcumin as an anticancer hero is tempered by the realities that their review has unearthed, and they end their paper on a low note: “Curcumin is not immune from side effects, such as nausea, diarrhea, headache, and yellow stool. Moreover, it showed poor bioavailability due to the fact of low absorption, rapid metabolism, and systemic elimination that limit its efficacy in diseases treatment. Further studies and clinical trials in humans are needed to validate curcumin as an effective anticancer agent.”

Meanwhile, an earlier study published in journal Current Pharmacology Reports established that besides diabetes, bitter melon is effective in treating other chronic diseases such as cancer and Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).

The study is titled “Bitter Melon as a Therapy for Diabetes, Inflammation, and Cancer: a Panacea?” The researchers noted: “Over the last few decades, multiple well-structured scientific studies have been performed to study the effects of bitter melon in various diseases. Some of the properties for which bitter melon has been studied include: antioxidant, anti-diabetic, anticancer, anti-inflammatory, antibacterial, antifungal, antiviral, anti-HIV, anthelmintic, hypotensive, anti-obesity, immuno-modulatory, anti-hyperlipidemic, hepato-protective, and neuro-protective activities. This review attempts to summarize the various literature findings regarding medicinal properties of bitter melon. With such strong scientific support on so many medicinal claims, bitter melon comes close to being considered a panacea.”

According to Food as Medicine: Functional Food Plants of Africa published 2017 by CRC Press, “…Dietary use of bitter melon or its juice decreases blood glucose levels, increases High Density Lipo-protein (HDL)/good cholesterol, and decreases triglyceride levels, thus exhibiting antiatherogenic qualities. Extract of bitter melon in supplement form has been widely used as a traditional medicine for diabetic patients.

When administered alone, it has a modest hypoglycemic effect at doses of at least 2000 mg/day. This botanical supplement enhances the cellular uptake of glucose and promotes insulin release, potentiating its effect, and in animal studies has been shown to increase the number of insulin-producing beta cells in diabetic animals. Bitter melon has also been found to reduce adiposity and oxidative stress in addition to reducing blood triglycerides and Low Density Lipo-proteins (LDL)/bad cholesterol.”

Asthma is a chronic lung condition in which the airways narrow and become inflamed, which leads to wheezing, coughing, and chest tightness. Extrinsic asthma and intrinsic asthma are subtypes of asthma.

The symptoms of these subtypes are the same, but they have different triggers:

  • Extrinsic asthma symptoms occur in response to allergens, such as dust mites, pollen, and mold. It is also called allergic asthma and is the most common form of asthma.
  • Intrinsic asthma has a range of triggers, including weather conditions, exercise, infections, and stress. People may call it nonallergic asthma.

In this article, we discuss the causes, symptoms, and treatment of intrinsic and extrinsic asthma.

Intrinsic vs. extrinsic asthma

Intrinsic and extrinsic asthma are two subtypes of asthma, which people more commonly refer to as allergic and nonallergic asthma.

Both types cause the same symptoms. The difference between the two subtypes is what causes and triggers asthma symptoms. The treatments are similar for each type, although the prevention strategies differ.

Triggers

Woman taking inhaler for asthma whilst playing football. Intrinsic and extrinsic asthma have the same symptoms but different triggers
Intrinsic and extrinsic asthma have the same symptoms but different triggers.

In people with extrinsic asthma, allergens trigger the respiratory symptoms. Common triggers for extrinsic asthma include:

  • pollen
  • mold
  • dust mites
  • pet dander
  • cockroaches
  • rodents

In some cases, a person is allergic to more than one substance, and several allergens trigger asthma symptoms.

In people with intrinsic asthma, allergies are not responsible for the symptoms. Instead, the following triggers cause symptoms:

  • cold
  • humidity
  • stress
  • exercise
  • pollution
  • irritants in the air, such as smoke
  • respiratory infections, such as colds, the flu, and sinus infections

In some cases, intrinsic asthma can occur with no known cause.

Prevalence

Extrinsic or allergic asthma is the most common form of the disease. According to the Asthma and Allergy Foundation of America, about 60% of people with asthma have allergic asthma.

Less commonly, intrinsic or nonallergic asthma occurs. Research in The Journal of Allergy and Clinical Immunologyindicates that intrinsic asthma occurs in anywhere from 10% to 33% of people with asthma.

It occurs more often in females than males and typically develops later in life than extrinsic asthma.

Causes

In all types of asthma, a person has overly sensitive airways and airway inflammation, which produces asthma symptoms.

Inflammation causes swelling in the airways that narrows the tubes and makes breathing difficult. The body also produces excess mucus, which further impairs breathing. These factors decrease the amount of air that can get into the lungs.

The inflammatory processes are similar in extrinsic and intrinsic asthma. In both, the immune system releases cells called T-helper cells and mast cells.

Research has found that there may be more similarities between the two types of asthma than researchers previously thought. Both types of asthma involve the production of IgE locally at the airways in response to the relevant triggers:

  • Extrinsic asthma occurs when the immune system overreacts to a harmless substance, such as pollen or dust. The body releases an antibody called immunoglobin E (IgE). The release of this antibody leads to inflammation and asthma symptoms.
  • Intrinsic asthma occurs when something other than allergens triggers an immune system response. People are not always able to identify the trigger.

Symptoms

The symptoms of extrinsic and intrinsic asthma are the same and may include:

  • wheezing
  • chest tightness
  • shortness of breath
  • coughing
  • increased mucus production
  • trouble breathing

Symptoms can vary in severity and may develop suddenly. Ignoring the signs and symptoms of an asthma attack can lead to a life-threatening situation. Recognizing symptoms as soon as possible and following an asthma action plan can help decrease the severity of an attack and reduce complications.

Treatments

The treatment options for intrinsic and extrinsic asthma are similar and include medications, lifestyle changes, and the avoidance of triggers. Since the triggers are different, the prevention strategies may differ.

Reducing triggers

It may be easier to identify the triggers for extrinsic asthma because allergies are the culprit. With both types of asthma, the identification of triggers allows an individual to take steps to reduce exposure and decrease symptoms.

The following steps can help reduce asthma symptoms in people with extrinsic asthma:

  • fixing leaky pipes to prevent mold buildup
  • keeping doors and windows closed when the pollen count is high
  • vacuuming often to reduce dust
  • keeping pets out of the bedroom

Triggers of intrinsic asthma do not involve a specific allergen. Due to the variability of triggers, it can take a little longer to determine the cause of flare-ups. People may find that avoiding humid, dry, or cold weather can prevent symptoms.

Medications

People can use the following medications to treat flare-ups of both intrinsic and extrinsic asthma:

Short-acting bronchodilators

Short-acting bronchodilators, also called quick relief medications, reduce symptoms fast. They work by relaxing the muscles of the airways.

Long-acting medications

People take long-acting bronchodilators daily, and they also open up the airways. Long-acting bronchodilators do not treat sudden symptoms as they take longer to work than short-acting bronchodilators.

Corticosteroids

Corticosteroids decrease inflammation in the airways. People take steroids daily to prevent symptoms.

Omalizumab

Omalizumab is an anti-IgE antibody therapy that prevents the release of IgE. Reducing IgE decreases the allergic response and prevents asthma symptoms.

People usually use omalizumab to treat extrinsic asthma, but it may also help with intrinsic asthma.

Lifestyle changes

Lifestyle changes might also help decrease symptoms of both types of asthma.

People with asthma may wish to consider adopting the following lifestyle practices:

  • maintaining a healthy weight
  • quitting smoking
  • avoiding secondhand smoke
  • reducing stress
  • getting a flu vaccine each year
  • washing the hands frequently to decrease the risk of infection

Outlook

Although there is currently no cure for either extrinsic or intrinsic asthma, people can manage the symptoms with medications, prevention methods, and lifestyle changes.

Intrinsic asthma is often harder to control than extrinsic asthma, as identifying its triggers is sometimes difficult. People can work closely with a doctor to determine the causes of asthma symptoms and find an effective treatment.

Anxiety commonly causes a change in appetite. Some people with anxiety tend to overeat or consume a lot of unhealthful foods. Others, however, lose their desire to eat when they feel stressed and anxious.

Anxiety is a mental health condition that affects 40 million adults in the United States each year. Changes in appetite are one of many possible symptoms.

Keep reading to learn more about the link between anxiety and a loss of appetite, some potential remedies and treatments for the problem, and some other common causes of appetite loss.

Anxiety and appetite loss

When someone starts to feel stressed or anxious, their body begins to release stress hormones. These hormones activate the sympathetic nervous system and trigger the body’s fight-or-flight response.

The fight-or-flight response is an instinctive reaction that attempts to keep people safe from potential threats. It physically prepares the body to either stay and fight a threat or run away to safety.

This sudden surge of stress hormones has several physical effects. For example, research suggests that one of the hormones — corticotropin-releasing factor (CRF) — affects the digestive system and may lead to the suppression of appetite.

Another hormone, cortisol, increases gastric acid secretion to speed the digestion of food so that the person can fight or flee more efficiently.

Other digestive effects of the fight-or-flight response can include:

  • constipation
  • diarrhea
  • indigestion
  • nausea

This response can cause additional physical symptoms, such as an increase in breathing rate, heart rate, and blood pressure. It also causes muscle tension, pale or flushed skin, and shakiness.

Some of these physical symptoms can be so uncomfortable that people have no desire to eat. Feeling constipated, for example, can make the thought of eating seem very unappetizing.

Overeating vs. appetite loss

People who have persistent anxiety or an anxiety disorder are more likely to have long-term heightened levels of CRF hormones in their system. As a result, these individuals may be more likely to experience a prolonged loss of appetite.

On the other hand, people who experience anxiety less frequently may be more likely to seek comfort from food and overeat. However, everyone reacts differently to anxiety and stress, whether it is chronic or short-term.

In fact, the same person may react differently to mild anxiety and high anxiety. Mild stress may, for example, cause a person to overeat. If that person experiences severe anxiety, however, they may lose their appetite. Another person may respond in the opposite way.

Men and women may also react differently to anxiety in terms of their food choices and consumption.

One study indicates that women may eat more calories when anxious. The study also links higher anxiety with a higher body mass index (BMI) in women but not in men.

Remedies and treatment

Individuals who experience a loss of appetite due to anxiety should take steps to address the issue. Long-term appetite loss can lead to health problems. Potential remedies and treatments include:

1. Understanding anxiety

Simply realizing that sources of stress can trigger physical sensations can go some way toward reducing anxiety and its symptoms.

2. Addressing sources of anxiety

Identifying and dealing with anxiety triggers can sometimes help people regain their appetite. Where possible, individuals should work to eliminate or reduce stressors.

If this proves challenging, a person may wish to consider working with a therapist who can help them manage anxiety triggers.

3. Practicing stress management

Several techniques can effectively reduce or control anxiety symptoms, including appetite loss. Examples include:

  • deep breathing exercises
  • guided imagery practice
  • meditation
  • mindfulness
  • progressive muscle relaxation

4. Choosing nutritious, easily digestible foods

If people cannot eat much, they should ensure that what they do eat is nutrient-rich. Some good choices include:

  • soups containing a protein source and a variety of vegetables
  • meal-replacement shakes
  • smoothies containing fruits, green leafy vegetables, fat, and protein

It is also a good idea to opt for easily digestible foods that will not further upset the digestive system. Examples include rice, white potato, steamed vegetables, and lean proteins.

People with symptoms of anxiety may also find it beneficial to avoid foods that are high in fat, salt, or sugar, as well as high-fiber foods, which can be difficult to digest.

It can also help to limit the consumption of drinks containing caffeine and alcohol, as these often cause digestive problems.

5. Eating regularly

Getting into a regular eating pattern can help the body and brain regulate hunger cues.

Even if someone can only manage a few bites at each mealtime, this will be better than nothing. Over time, they can increase the amount that they eat at each sitting.

6. Making other healthful lifestyle choices

When a person is anxious, they may find it difficult to exercise or sleep. However, both sleep and physical activity can reduce anxiety and increase appetite.

Individuals should try to get enough sleep each night by setting a regular sleep schedule.

They should also aim to exercise most days. Even short bursts of gentle exercise can be helpful. People who are new to exercise can start small and increase the duration and intensity of activities over time.

When to see a doctor

People should see a doctor if their appetite loss persists for 2 weeks or more, or if they lose weight rapidly. A doctor can check for an underlying physical condition that may be causing symptoms.

If the loss of appetite is purely a result of stress, a doctor can suggest ways to manage the anxiety, including therapy and lifestyle changes.

They may also prescribe medication to those with chronic or severe anxiety.

Other causes of appetite loss

Anxiety is not the only cause of appetite loss. Other possible causes include:

  • Depression: As with anxiety, feeling depressed can cause a loss of appetite in some people but lead others to overeat.
  • Gastroenteritis: Also known as a stomach bug, gastroenteritis can cause vomiting, diarrhea, and loss of appetite.
  • Medication: Some medications, including antibiotics and certain pain relievers, can reduce appetite. They can also cause side effects that include diarrhea or constipation.
  • Intense exercise: Some people, especially endurance athletes, experience gastrointestinal symptoms such as nausea, vomiting, and intestinal cramping after periods of intense activity, which may result in a loss of appetite.
  • Pregnancy: Some pregnant women may lose their appetite due to morning sickness or because of pressure on the stomach.
  • Illness: Certain medical conditions, such as diabetes or cancer, can lead to a reduction in appetite.
  • Aging: Appetite loss is common among older adults, possibly due to a loss of taste and smell or because of illness or medication use.

Summary

Anxiety can cause a loss of appetite or an increase in appetite. These effects are primarily due to hormonal changes in the body, but some people may also avoid eating as a result of the physical sensations of anxiety.

Individuals who experience chronic or severe anxiety should see their doctor.

Sometimes, there may be other reasons for appetite loss that also require treatment.

Once a person addresses the anxiety, their appetite will typically return. Without treatment, long-term appetite loss and chronic anxiety can have serious health consequences.

Walnuts may not just be a tasty snack, they may also promote good-for-your-gut bacteria. New research suggests that these “good” bacteria could be contributing to the heart-health benefits of walnuts. In a randomized, controlled trial, researchers found that eating walnuts daily as part of a healthy diet was associated with increases in certain bacteria that can help promote health. Additionally, those changes in gut bacteria were associated with improvements in some risk factors for heart disease.

Kristina Petersen, assistant research professor at Penn State, said the study — recently published in the Journal of Nutrition — suggests walnuts may be a heart- and gut-healthy snack.

“Replacing your usual snack — especially if it’s an unhealthy snack — with walnuts is a small change you can make to improve your diet,” Petersen said. “Substantial evidence shows that small improvements in diet greatly benefit health. Eating two to three ounces of walnuts a day as part of a healthy diet could be a good way to improve gut health and reduce the risk of heart disease.”Previous research has shown that walnuts, when combined with a diet low in saturated fats, may have heart-healthy benefits. For example, previous work demonstrated that eating whole walnuts daily lowers cholesterol levels and blood pressure.

According to the researchers, other research has found that changes to the bacteria in the gastrointestinal tract — also known as the gut microbiome — may help explain the cardiovascular benefits of walnuts.“There’s a lot of work being done on gut health and how it affects overall health,” said Penny Kris-Etherton, distinguished professor of nutrition at Penn State. “So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease.”

For the study, the researchers recruited 42 participants with overweight or obesity who were between the ages of 30 and 65. Before the study began, participants were placed on an average American diet for two weeks. After this “run-in” diet, the participants were randomly assigned to one of three study diets, all of which included less saturated fat than the run-in diet. The diets included one that incorporated whole walnuts, one that included the same amount of alpha-linolenic acid (ALA) and polyunsaturated fatty acids without walnuts, and one that partially substituted oleic acid (another fatty acid) for the same amount of ALA found in walnuts, without any walnuts.

In all three diets, walnuts or vegetable oils replaced saturated fat, and all participants followed each diet for six weeks with a break between diet periods. To analyze the bacteria in the gastrointestinal tract, the researchers collected fecal samples 72 hours before the participants finished the run-in diet and each of the three study diet periods. “The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” Petersen said. “One of those is Roseburia, which has been associated with protection of the gut lining. We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers also found that after the walnut diet, there were significant associations between changes in gut bacteria and risk factors for heart disease. Eubacterium eligens was inversely associated with changes in several different measures of blood pressure, suggesting that greater numbers of Eubacterium eligens was associated with greater reductions in those risk factors.

Additionally, greater numbers of Lachnospiraceae were associated with greater reductions in blood pressure, total cholesterol, and non-High Density Lipo-protein (HDL) cholesterol. There were no significant correlations between enriched bacteria and heart-disease risk factors after the other two diets.

Regina Lamendella, associate professor of biology at Juniata College, said the findings are an example of how people can feed the gut microbiome in a positive way. “Foods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber and bioactive compounds — for our gut microbiomes to feed on,” Lamendella said. “In turn, this can help generate beneficial metabolites and other products for our bodies.” Kris-Etherton added that future research can continue to investigate how walnuts affect the microbiome and other elements of health.

“The findings add to what we know about the health benefits of walnuts, this time moving toward their effects on gut health,” Kris-Etherton said. “The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels.”

Fish Oil supplements could make men’s testicles bigger and boost their sperm count, a study claims.Men who took the pills, which contain omega-3 fatty acids, were found to have testicles 1.5ml larger and to ejaculate 0.64ml more sperm, on average.The men, who had an average age of 18, were included as regular supplement-takers if they had consumed fish oil for at least 60 out of the past 90 days. Larger testicles and more sperm creation are linked to higher testosterone levels and better fertility, although the study did not test how fertile the men were.

The research was published in the journal JAMA Network Open, by the American Medical Association. The experiment was described by scientists as ‘well-conducted’ and ‘insightful’ but it was clear that it did not prove fish oil makes men more fertile. Researchers from the University of Southern Denmark did their study using 1,679 young Danish men going through military fitness testing.

In Denmark military service is mandatory for all healthy men over the age of 18, so the men in the study were not yet soldiers. Each of the men was screened for Sexually Transmitted Infections (STIs), had physical exams, gave sperm samples and then answered questions about their diets and lifestyles. If someone was considered a regular fish oil supplement user, the research found, they produced millions more sperm in an average ejaculation.

The researchers wrote in their paper: “Fish oil supplements were associated … with higher semen volume and total sperm count, and larger testicular size.”Ninety-eight men in the study said they took fish oil supplements regularly, while another 95 took vitamin D or C supplements. Men in the fish oil group were less likely to have fertility problems, which were judged against the World Health Organization’s low sperm count limit of 39 million sperm per ml of semen.

The scientists found that 12.4 percent of the men who took fish oil supplements (12 out of 98) had sperm counts below the World Health Organisation’s (WHO’s) measure. This compared to 17.2 percent (192 out of 1,125) men who took no supplements. And the longer someone had been taking supplements for, the more sperm they were likely to produce.

The researchers added that, based on a model fit and healthy 19-year-old: “Total sperm count was 147million for men with no supplement intake, 159million for men with other supplement intakes, 168million for men with fish oil supplement intake on fewer than 60 days, and 184million for men with fish oil supplement intake on 60 or more days.”

The study did not give exact measurements for men’s testicle volume or sperm volumes – they only compared the two groups. And the scientists could not explain why – if it was true – the fish oil improved sperm quality.It was also not clear whether increased sperm volume was caused by – or caused – the change in testicle size. Scientists not involved with the research said the study had been well-conducted but it didn’t say how much fish oil the men took.

And nor did it reveal the men’s diets, which may have shown they were getting omega-3 from other sources such as fresh fish.Professor Sheena Lewis, reproductive medicine expert at Queen’s University, Belfast, said: “This is a large well-designed study and the association between fish oil intake and improved semen quality is compelling.

“However, the study focuses on healthy young men; mostly with sperm counts already in the fertile range.“There is no evidence from this study that infertile men with low sperm counts benefit from fish oil.”Dr. Frankie Phillips, of the British Dietetic Association, said missing information about the men’s diets did make the study’s results less convincing.She added: “Antioxidants, including vitamin C, selenium and vitamin A, as well as zinc and omega-3 fats all have a role in the production of healthy sperm.

“There is much focus on the diets of women who are trying to conceive, ensuring that they are in the best possible position to achieve a healthy pregnancy, but diet might also be a factor involved in men’s reproductive health.“Omega-3 is present in a both animal and plant derived foods, but oily fish stands out as an excellent source of long chain omega-3, and the UK population currently consume way below the recommended ‘at least one portion of oily fish per week”.

“So including omega-3 is already part of current dietary recommendations – this study on its own can’t prove that upping omega-3 will itself improve testicular function.”Also, according to researchers, women who have sex every week may have a lower chance of an early menopause. University College London experts asked nearly 3,000 women – who were tracked for 10 years – about how often they had sex. Women of any age who had sex each week were less likely to have been through the menopause, compared to those who did so less than once a month.

For example, those who had regular sex were 28 percent less likely to have entered the menopause at age 51, compared to their counterparts. Sexual activity included full-blown intercourse, oral sex, touching and caressing, or self-stimulation. Scientists said if a woman is not having sex and there is no chance of pregnancy, the body ‘chooses’ to stop investing energy into ovulation.

Instead, their bodies may decide to invest energy elsewhere, such as in looking after grandchildren. The theory, known as the grandmother hypothesis, says the menopause evolved to help mothers have more children. It suggests that grandmothers would aid their offspring to have more of their own children by caring for the existing grandchildren. A woman’s immune function is hampered during ovulation, making the body more susceptible to disease.

And so if a pregnancy is unlikely because of a lack of sexual activity, the body would divert its focus from a costly process to aiding existing relatives. The menopause is when a woman stops having periods and is no longer able to get pregnant naturally. The process is a natural part of ageing and usually occurs among women between 45 and 55. Researchers used data collected from 2,936 women who took part in the Study of Women’s Health Across the Nation (SWAN) in the United States (U.S.).

The women, an average age of 45 at the start of the study in 1996, were asked if and how often they had had sex in the past six months. They were also asked whether they had oral sex, sexual touching, or engaged in self-stimulation in the last six months. The researchers found that the most frequent pattern of sexual activity was weekly (64 percent). None of the women who took part had already entered the menopause, but 46 per cent were starting to experience symptoms (known as peri-menopause). Fifty-four per cent were pre-menopausal, meaning they had not yet displayed any symptoms and were still having their periods.

Interviews were carried out both when the women first took part and then ten years later. Women who had sex weekly were less likely to experience the menopause, compared to those who had sex lass than monthly. And women who had sex monthly were less likely to experience menopause at any given age, compared to those who had sex less than monthly. Prof. Ruth Mace, who co-authored the study, said: “The menopause is, of course, an inevitability for women, and there is no behavioural intervention that will prevent reproductive cessation.“Nonetheless, these results are an initial indication that menopause timing may be adaptive in response to the likelihood of becoming pregnant.”

How can a man’s diet affect his fertility?
The body must get all the chemicals it needs from the diet, meaning what you eat controls your health. Certain foods can improve – or worsen – a man’s fertility. The general rule is that a healthy, balanced diet is better for fertility than one too high in sugar or fat.

Fruits and vegetables are good
Fruit and veg are rich in nutrients such as vitamins C and A, polyphenols, magnesium, folate and fiber, which act as antioxidants in the body. Research has suggested a direct association between the production of reactive oxygen species in sperm cells and intake of antioxidants, which help to reduce this damage by neutralizing them.

Eat foods rich in zinc, selenium and vitamin C
Zinc can be found in foods such as meat, cheese, shellfish wholegrain cereals and nuts. Inadequate intakes of zinc in the diet have been linked to low sperm count and reduced testosterone levels. Selenium can be found in foods such as brazil nuts, fish, poultry and eggs. This mineral is required for normal sperm production and development and men should aim to get 55mcg per day. Vitamin C is thought to help prevent sperm cells clumping together (common with infertility) and men should aim to get 80mg per day.

Limit dairy foods
Intake of dairy foods in association with sperm production is somewhat controversial but the theory goes that as around 75 per cent of the milk we consume comes from pregnant cows, there may be a high level of naturally occurring oestrogens, which could affect sperm production.

Limit meat intake
Although not fully proven, it has been suggested that meat and processed meats may impact on fertility in men by way of xenobiotics (mainly xenestrogens) used in the farming process. Over-exposure to these compounds, which have estrogenic effects in the body, may play a role in the decline of sperm quality in men.

Avoid excessive amounts of sugar
Excessive intake of sugary foods may lead to overweight and obesity, driving insulin resistance, which may negatively influence sperm quality as a result of inflammation and oxidative stress. Diets high in sugar can also lead to blood sugar imbalances, which may disrupt the hypothalamic-pituitary-testicular axis impacting on sperm production.
*Culled from Daily Mail UK

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.