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Thursday, April 18, 2024
Reproductive Functions

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Colorectal cancer is the second most common cause of cancer-related death in the United States.

The incidence of EO-CRC, which refers to when people under 50 years of age develop the condition, has increased markedly in several wealthy countries.

One 2020 article in CA: A Cancer Journal for Clinicians suggested that over the course of the year, about 150,000 U.S. individuals would receive a diagnosis of colorectal cancer and about 53,200 would die as a result.

The authors also predicted about 18,000 cases of individuals younger than 50 years of age receiving a diagnosis of colorectal cancer, with 3,640 forecasted deaths in this population.

Compared with adults born in the U.S. around 1950, those born around 1990 have twice the risk of developing colon cancer and four times the risk of developing rectal cancer.

A new study in the journal Gut links drinking two or more SSBs per day in adulthood with a doubling in the risk of bowel cancer before the age of 50 years.

Researchers found that each daily SSB serving among adult women may be associated with a 16% higher risk of developing EO-CRC.

Also, the study found that each additional SSB serving per day among individuals aged 13–18 years may be linked to a 32% increase in the risk of developing EO-CRC.

Examples of SSBs include soft drinks, pre-packaged fruit drinks, energy drinks, and sports drinks. Sugary drinks are the leading source of added sugars in the American diet.

In fact, from 1977 to 2001, energy intake from SSBs increased by a whopping 135%.

Unique epidemiologic evidence

For this study, the researchers used data from 95,464 participants in the Nurses’ Health Study II. This is an ongoing monitoring study of 116,430 U.S. registered nurses, all women, who were aged 25–42 years when they enrolled in 1989.

Every 4 years beginning in 1991, the women in the study reported on what they ate and drank using validated food frequency questionnaires.

In 1998, researchers asked the participants to recall their health status and lifestyle habits as teenagers.

Also, 41,272 of the women reported on what they typically ate and drank as well as on the quantities of these items between 1960 and 1982. They were aged 13–18 years at this point.

The participants also gave information on potentially influential factors, including their family history of bowel cancer, their lifestyle habits, and any regular use of aspirin, nonsteroidal anti-inflammatory drugs, or vitamin supplements.

Over 24 years of monitoring, 109 women developed bowel cancer before the age of 50 years.

The study authors write that their findings “add unique epidemiologic evidence that SSB intake may partly contribute to the rapid increase of CRC in younger adults.”

Notes on the study

It is important for researchers to understand what is behind this increase, said study co-author Dr. Jeffrey Meyerhardt. He is the clinical director of the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute in Boston, MA.

“It is presumed that exposures early in life are contributing to this rise,” Dr. Meyerhardt told Medical News Today. “Studying exposures that can be prevented is [essential] to getting control of this rising health issue.”

Substituting SSBs with reduced-fat milk or whole milk appears to be beneficial, according to study co-author Dr. Yin Cao. She is an associate professor of surgery at the Washington University School of Medicine in St. Louis, MO.

“In this study,” she told us, “we showed [that] replacing one daily serving (8 oz) of SSBs with an equivalent amount of reduced-fat milk or total milk was associated with a 35–36% lower risk of EO-CRC.”

“During the second half of the 20th century, for which average U.S. per capita soft drink consumption has dramatically increased by ~500%, milk consumption has declined by half. Milk is a good source of calcium, a mineral found to be protective of colorectal cancer.”

“We postulate [that] low milk consumption could be plausibly linked with the increased risk of EO-CRC, and further research on this topic is in the pipeline.”

The researchers point to several limitations of their study. First, they caution that this was an observational study, which can only establish correlation, not cause. They also note that the majority of the participants were white women, so the findings may not apply to men or other ethnic groups.

Even so, the study provides insight into possible actions that public health leaders might take, Dr. Cao explained.

“Particularly in adolescence,” she wrote, “the immature and rapidly growing organs could be more susceptible to exposures that could lead to cancer development.”

“Campaigns, education programs, and interventions targeting the young population to reduce SSB intake and/or replace SSBs with other healthier beverages could help reduce the accrual of time at risk and convert this window of increased susceptibility into an opportunity for better health outcomes later in life.”

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One in seven pregnancies worldwide ends in miscarriage, and eleven percent of women endure a failed pregnancy at least once in their lifetime, experts said Tuesday.

Some 23 million miscarriages occur every year, according to data pieced together from around the globe by an international team of 31 researchers.

But the actual tally is sure to be “substantially higher” due to underreporting, they said in a trio of studies published in The Lancet.

Two percent of women — one in 50 — have experienced two miscarriages, while less that one percent have been through three or more.

Levels of care for women suffering miscarriage is highly uneven across countries, and even within many wealthy nations, the data showed.

“A new system is needed to ensure miscarriages are better recognised and women are given the physical and mental health care they need,” the researchers said in a statement.

Misconceptions about miscarriage are widespread.

Many women believe they occur only rarely, for example, or that they can be caused by lifting heavy objects or previous contraceptive use.

They may also think that there’s no effective treatments to prevent a miscarriage, especially in women at high risk.

Such misconceptions can be damaging, leaving women and their partners feeling at fault and discouraging them from seeking treatment and support, the authors note.

Miscarriage can also lead to isolation, since many women might not tell their family, close friends, or even their partner about the loss of a pregnancy.

“Silence around miscarriage remains not only for women who experience it, but also among health care providers, policymakers and research funders,” said co-lead author Siobhan Quenby, a professor at the University of Warwick and director of Tommy’s National Centre for Miscarriage Research.

A miscarriage is widely defined as the loss of a pregnancy before 20 to 24 weeks of gestation, with the exact time period varying from country to country.

Unrecognised trauma
A review of published academic literature up to mid-May 2020 identified many causes for miscarriages, including a more advanced maternal age, previous miscarriages, and a father older than 40.

Other risk factors correlating with pregnancies that end spontaneously are being extremely under- or over-weight, smoking, alcohol consumption, persistent stress, working night shifts, and constant exposure to air pollution or pesticides.

Health consequences can be severe, especially for women who experience a second or multiple miscarriages.

“Recurrent miscarriage is a devastating experience for most women, but the mental health impact is rarely acknowledged or addressed in medical care,” said co-lead author Arri Coomarasamy, from the University of Birmingham.

“Women can experience trauma and bereavement, which may have no obvious sign and can go unrecognised.”

There is also a link with anxiety, depression and — for about 20 percent of women — post-traumatic stress disorder nine months after a miscarriage.

The authors of the three studies noted that most data comes from wealthier nations, but that the “silence around miscarriage” is found everywhere.

They recommended that national health authorities strengthen miscarriage care services, improve research in prevention, and identify women at high risk.

“For too long miscarriage has been minimised and often dismissed,” The Lancet said in an companion editorial.

“The lack of medical progress should be shocking — instead, there is pervasive acceptance.”

“The era of telling women to ‘just try again’ is over,” The Lancet said.

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Stressful events — such as sitting an exam, giving a presentation, or attending a job interview — temporarily increase heart rate and blood pressure and dilate arteries.

This is a normal part of the body’s “fight-or-flight” response, but the lining of blood vessels, known as the endothelium, can take up to 90 minutes to recover after this kind of stress.

This may help to explain why a single episode of stress temporarily increases the risk of an acute cardiovascular event, such as a heart attack.

On the other hand, experts know that eating a diet rich in fruits and vegetables reduces a person’s risk of cardiovascular disease, heart attacks, and cardiovascular mortality.

Among the healthy nutrients found in fruits and vegetables are polyphenolic compounds known as flavanols. In the long term, these improve endothelial function and lower blood pressure.

The effects of flavanols during stress and in its immediate aftermath are unknown, however.

Scientists at the University of Birmingham in the United Kingdom have conducted the first study to investigate this question.

Their research suggests that drinking cocoa, which is rich in flavanols, in the hours before a stressful event can improve blood flow during the experience and help restore endothelial function in males aged under 45 years old afterward.

“Our findings are significant for everyday diet, given that the daily dosage administered could be achieved by consuming a variety of foods rich in flavanols — particularly apples, black grapes, blackberries, cherries, raspberries, pears, pulses, green tea, and unprocessed cocoa,” says senior author Dr. Catarina Rendeiro, Ph.D., of the university’s School of Sport, Exercise and Rehabilitation Sciences.

“This has important implications for measures to protect the blood vessels of those individuals who are more vulnerable to the effects of mental stress,” she adds.

The research, conducted by postgraduate student Rosalind Baynham, appears in the journal Nutrients.

Stress tests

The scientists recruited 30 healthy males between 18 and 45 years who underwent tests at the lab on two separate occasions at least 7 days apart.

The research involved them fasting for 12 hours before each session and abstaining from alcohol, vigorous exercise, and polyphenol-rich food and drink for 24 hours beforehand.

At the start of each visit, while the participants were relaxed, researchers assessed their “brachial flow-mediated dilatation,” which is a measure of endothelial function.

They also measured their blood pressure, heart rate, and blood flow.

On one of these visits, the participants drank regular cocoa, which is rich in flavanols, and on the other visit, they drank a special cocoa drink that was low in flavanols.

About 90 minutes later, they took a competitive test of mental arithmetic designed to elicit stress.

For example, during the test, the researchers filmed the participants, and they had to watch their performance on a screen. The researchers told the participants that “body language assessors” would assess them.

The arithmetic task got progressively faster, and the participants lost points whenever they got an answer wrong.

An experimenter in the room marked their responses and sounded an alarm when they made a mistake, or once every 10 answers if they did not.

At 30 and 90 minutes after the stress test, the researchers remeasured the participants’ endothelial function and blood pressure.

The results showed that 30 minutes after the stress test, all participants had impaired endothelial function. This measure remained significantly higher 90 minutes after the stress test.

However, participants who drank the high-flavanol cocoa saw smaller declines in endothelial function than those who consumed the low-flavanol cocoa.

In addition, high-flavanol cocoa increased blood flow during and after the test compared with low-flavanol cocoa.

Other cardiovascular and blood pressure measures were similar for both conditions.

Future investigations

The researchers note that the main limitation of their study was that it excluded females.

They report that, for the sake of consistency, they wanted to avoid the impact of hormonal fluctuations during the female menstrual cycle on the vascular changes under investigation.

This means that it is not possible to apply the outcomes of this study to females. Researchers remain unclear on the impact of flavanols on stress response in females.

However, existing evidence shows there are gender differences in how a body responds to stress. So, future studies should focus on females.

The researchers also write that a more in-depth investigation would include molecular measures of cardiovascular function. These should consist of nitric oxide, which is a signaling molecule that dilates blood vessels, and the stress hormone cortisol.

Finally, they write that future research should explore the effect of flavanol intake on stress responses in individuals at higher risk of cardiovascular diseases, such as high blood pressure, and people who experience mental stress, such as care workers.

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According to existing data, at least one in every 10 women live with endometriosis. Although this condition can have a serious impact on the quality of life, it often takes women years to have it diagnosed. Medical News Today speak to women living with this condition to find out more about their long journey to a diagnosis.

This issue can affect all people assigned as female at birth, but it often goes undiagnosed, partly due to gender stereotyping.

Available data indicate that around 10–15%Trusted Source of all women live with endometriosis, a chronic condition in which tissue similar to uterine lining grows outside the uterus.

The severe pain and bleeding and other incapacitating symptoms that often accompany endometriosis mean that the life quality of those who live with this condition is impacted in serious ways.

Despite this, it can take anywhere between 4 and 11 years for women to receive the correct diagnosis, and as many as six out of every 10 cases of endometriosis may remain undiagnosed.

Medical News Today have spoken to three women with diagnosed endometriosis to find out more about their experience of obtaining a diagnosis: what made it difficult, whether the treatment they received was helpful, and how this chronic condition has been affecting their lives.*

For an informed perspective on the difficulties that accompany the task of raising awareness of the facts versus myths about endometriosis, we have also spoken to Jenneh Rishe, a registered nurse and founder of the nonprofit organization The Endometriosis Coalition.

Why does it take so long to diagnose?

The most recognizable symptomTrusted Source that accompanies endometriosis is debilitating pain, not just in the pelvic area but also of the lower back, during bowel movements and during or after sexual intercourse with vaginal penetration.

While the pain often occurs during menstruation, it can also occur between periods due to the lesions and scarringTrusted Source caused by endometriosis.

Alma, one of the women who spoke to MNT about their experience, said that she realized she might have endometriosis when “[t]he pain had moved from just my ovaries to my intestines and overall stomach area.”

“[A]fter many MRIs and ultrasound scans, they concluded that I must have endometriosis, based on symptoms alone,” she added.

“Some common misconceptions [about this chronic condition] are that endometriosis is just a bad period, when, in reality, it is a highly inflammatory, full-body disease,” Rishe told MNT.

“To date, endometriosis has been found in every single organ in the body. The symptoms range from abdominal pain to brain fog and fatigue, to chest pain and shortness of breath, to nerve pain and pain with urinating. The symptoms are all over the map, and they don’t only happen during someone’s period. They can be every single day,” she explained.

Because endometriosis can affect so many parts of the body — including the vagina and rectum, intestines, bladder, and diaphragm — doctors may misdiagnose it as a different chronic condition.

Another woman, Martha, also told us that it was only when she started to experience chronic pain between periods that she realized she might have a gynecologic condition.

“I’ve had painful periods my entire life, but for a long time, I’d never heard of endometriosis. Around my mid-20s, I started to experience pain more often, not just during my period,” she said.

“I just happened to hear about endometriosis online, on social media. At first, I didn’t identify with it, because I’d been told that period pain is normal. But as the severity of my symptoms increased, I started to wonder if maybe this wasn’t so normal. I believe I was 28 years old when the pain and other symptoms started happening daily and just didn’t stop. That was when I started looking into endometriosis more seriously and began to suspect that I had it.” – Martha

Another contributor, Lisa, told us that she had a similar experience: “I realized that I might have endometriosis after receiving abnormal results from a transvaginal ultrasound. I visited my general OB-GYN after experiencing abnormal bleeding and increasingly debilitating pelvic pain during both ovulation and menstruation.”

In her case, too, it took many attempts at a diagnosis until she received the correct one — and only then, it was after specifically seeking the advice of an expert in endometriosis.

“I was told that the shape of my uterus was suggestive of adenomyosis, and while doing some research with the help of […] various online support communities, I learned about the relationshipTrusted Source between adenomyosis and endometriosis. My symptoms aligned with the most common symptoms of endometriosis, so I found an endometriosis excision expert in my area and sought his care.” – Lisa

Currently, the generally accepted way of diagnosing endometriosis with certainty is through a laparoscopic surgery, which allows doctors to see the endometriosis lesions.

‘Everyone assumed it was just a painful period’

The misdiagnoses and wide array of symptoms may contribute to how long it takes healthcare professionals to diagnose this condition.

In Martha’s case, “it was almost 3 years between beginning to pursue a diagnosis and finally getting one.” For Alma and Lisa, it took well over a decade to receive a formal diagnosis.

“I was formally diagnosed with [endometriosis] around the age of 30, despite the fact that I’d had extremely painful periods since the age of 14,” Alma told us.

For her part, Lisa said: “I first sought care for the debilitating nature of my periods when I was around 16, and did not receive my diagnosis until I was 25. It’s hard to say when my symptoms officially started, but looking back, I would guess that I experienced them for well over 10 years before being diagnosed.”

Yet the complexity of endometriosis symptoms is only half of the story when it comes to the delays in diagnosing the condition.

When women seek help for chronic pain associated with or triggered by their periods, they often hear that this experience is “normal,” just a “bad period” that they have to find ways to cope with.

This was Alma’s experience, which she recalled with frustration. Even upon diagnosis, she said:

“I was offered no treatment apart from very strong pills, many of which [have] been discontinued since due to their dangerous side effects. […] Mostly, I was just told to deal with it. Everyone just assumed it was just ‘a painful period.’ Nobody seemed to think it was a condition, nobody regarded it as something that was even worthy of treatment. […] And I have seen a lot of gynecologists in my life, particularly in my teens and early 20s. It was just assumed that it was a ‘normal’ albeit very painful period, despite the fact that I would have pain and vomiting to the point of faint[ing] and [experiencing] visual hallucination[s].”

Alma’s experience ties in with worldwide reports of a gender pain gap — the phenomenon whereby women report more instances of chronic pain than men but are less likelyTrusted Source to be offered timely pain relief by healthcare professionals.

Why should this be so? One review of the existing literature, published in Pain Research and Management in 2018, suggests that the answer may lie in the persistence of gender stereotyping the experience of pain.

Studies about pain and healthcare, the review shows, tended to make questionable value judgments about men versus women and their subjective perception of pain.

“[M]en were presented as being stoic, in control, and avoiding seeking healthcare. Women, on the other hand, were presented as being more sensitive to pain and more willing to show and to report pain, compared [with] men,” the review authors write.

This suggests that women’s experience of chronic pain may get dismissed as exaggerated, a result of subjective, emotional oversensitivity rather than an objective physical experience.

Elusive treatments and management

There are many misconceptions about treatments and causes as well. Rishe told MNT that one misconception is “that pregnancy or hysterectomy are treatments for endometriosis.”

Another “major misconception is that [endometriosis] only affects those [in] their childbearing years, when, in reality, many adolescents and teens show signs of endo,” she noted.

Treatments for the management of endometriosis do exist, although they are far from perfect.

After receiving a diagnosis, women may be offeredTrusted Source an excision surgery, which will remove the abnormal growths of endometrial-like tissue. This excision does not stop the tissue from growing back, however, and repeated surgeries may follow to keep removing these growths.

Doctors may also offer an endometriosis management plan, depending on how much pain and bleeding a person experiences as a result of endometriosis.

In the first instance, doctors may prescribe the same drugs they would advise for the management of menstrual cramps: nonsteroidal anti-inflammatory drugs (NSAIDs)Trusted Source, which are over-the-counter pain relievers, such as ibuprofen.

Other prescribed treatments to manage endometriosis include hormone therapy, such as birth control pills, or the insertion of an intrauterine device (IUD).

None of these options, however, are ideal. NSAIDs often do not reduce the severe pain that endometriosis can cause, and both birth control pills and IUDs can produce side effects that further impact quality of life.

Martha told MNT that the treatments and coping strategies that her physicians offered kept falling short of their aim and did not help with her symptoms.

“When I told doctors I was having a hard time [with endometriosis] and needed treatment, they’d suggest trying a different form of birth control to help reduce cramps or lighten my period, but no birth control ever fully addressed my symptoms,” she recounted.

“Some doctors just suggested things like exercise and ibuprofen (which never even touched my pain). I was at the point where I could hardly even get out of bed some days, and I was just about ready to give up trying, because the ‘treatment’ options offered were so unhelpful.” – Martha

Martha told us that only excision surgery helped, but in the long term, she needed a solid management plan.

“Since [the surgery], treatments have included other forms of birth control, like an IUD and then Depo-Provera, changing my diet, and mindfulness tools like meditation,” she said.

Yet none of the formally offered options and treatments proved to be enough.

Martha felt she had to go beyond the doctor’s office and come up with her own coping strategies: “I’ve never really had options that addressed my symptoms completely, but my most consistently helpful treatments have been home remedies, like heating pads, TENS units, and medical cannabis.”

To go or not to go on ‘the pill’?

Birth control pills may help slow down the growth of endometrial-like tissue outside the uterus. However, they can have many side effects — including bleeding between periods, migraine, decreased libido, and mood changes.

Finding “the right pill” may feel like a gamble with high stakes: it could take months and trying various types of oral contraceptives until a woman lands on the one that causes her the least distress. With endometriosis, matters get even more complicated.

For some, birth control could work wonders. That was the case for Alma, who “was […] told [by doctors to] try the minipill to see if the symptoms [of endometriosis] go away, and if they do, then they can conclude that it was indeed endometriosis.”

“I did take the minipill, and the symptoms went away,” she said. Alma is still taking the “minipill” — a progestin-only birth control drug that may cause fewer side effects than regular combined pills, which contain both progesterone and estrogen.

For her, this strategy is successfully keeping endometriosis symptoms at bay. Lisa, however, did not experience the same relief and worried that birth control might mask symptoms rather than address them.

“I took birth control pills for 7 years and found no relief,” Lisa told us. “I also received minimal relief when using the NuvaRing,” she added.

“I refused IUDs and Nexplanon due to fear of side effects and inability to get the devices removed in a timely manner, if needed, which is something that folks with endometriosis and adenomyosis experience all too frequently. I want to stress that oral contraception and hormonal suppression are not effective treatments for endometriosis and that they often mask symptoms and delay formal diagnosis,” Lisa commented.

Why these differences? A 2018 study published in The Journal of Clinical Endocrinology and Metabolism found that it may all come down to the type of endometrial-like tissue growing outside of the uterus.

The study authors found a link between the progesterone receptor (PR) status of endometriosis lesions and whether or not they responded to progestin therapy.

In short, PR-positive lesions tended to respond to progestin therapy, and PR-negative lesions responded much less. This led the authors to suggest analyzing these lesions upon excision, to find out what kind of hormonal treatment they were most likely to respond to.

Pain, missed work, chronic fatigue

However, research on endometriosis — its mechanisms, causes, and treatments — continues to be very limited, which has prompted an outcry from those living with this chronic condition and researchers interested in studying it alike.

In 2017, a team of researchers from the Faculty of Health, Education, and Life Sciences at Birmingham City University in the United Kingdom interviewed women with endometriosis about their experiences in seeking a diagnosis and treatment for the condition.

The findings were stark. Study participants spoke of feeling “desperate,” having severe side effects from the treatments they received, and not being believed by those around them when they told of their experiences.

Dr. Annalise Weckesser, one of the researchers involved in this study, commented:

“Endometriosis has long been a neglected area of research and funding. We know that the average waiting time for women to receive a diagnosis is 7 years, which is unacceptable. Our pilot study shows that even once women receive a diagnosis, for some, their struggle with managing their symptoms has only begun.”

These symptoms are as many as they are severe. Each of the women who spoke to MNT about their experiences living with endometriosis emphasized this.

When asked how this chronic condition had impacted her quality of life, Martha said that, ironically, “[i]t might be easier to answer how it hasn’t affected my quality of life.”

“From the time I started menstruating at 12 years old, my periods have been debilitating. I’d throw up and pass out from the pain and often had to miss school because of it,” she told us.

“Once the pain became chronic, it really affected every part of my day. I couldn’t sleep, [I] had a hard time standing or sitting for long periods of time, sex was painful, and it also affected my mental health. I was really depressed and anxious — a few times, I had panic attacks when a flare-up started, because I knew the pain might get unbearable, and there was nothing I could do about it.” – Martha

“I had to stop working for a while and had a hard time finding work again because I needed flexibility to work from home during bad flare-ups,” she said. Add to this “a number of related physical problems, including leg pain and sciatica, bowel issues, and food sensitivities,” and the picture of pain is complete.

Self-reported data published in The Journal of Managed Care + Specialty PharmacyTrusted Source in 2017 indicate that, in a representative cohort of women aged 18–49 years with endometriosis, participants “lost an average of 1.1 hours of employment productivity because of absenteeism,” that is, missing work because of endometriosis symptoms, “and an average of 5.3 hours because of presenteeism,” or attending work while experiencing symptoms, per week.

“The most important and adverse impact [of endometriosis] was the fact that I had to explain to my bosses at work why I couldn’t function for 5 days a month or [why I] required working from home arrangements. When I used to work as a teacher, working from home wasn’t an option, so a lot of the time, I had to drag myself to class in immense pain,” Alma told MNT.

Lisa also spoke of the many days of school and work that she was forced to miss because of endometriosis symptoms.

“This disease has affected my life in so many ways,” she said. “On a very surface level, the disease has caused me to miss a lot of school, work, and time with loved ones.”

This has led her to come up with complex, multitiered coping strategies to try and minimize the impact on her daily activities:

“It has forced me to learn to budget my time and plan out everything that I do. Will eating at a certain restaurant aggravate my digestive symptoms? Will walking around a park or a store send me into a pain flare? Will going to class in the morning make me unable to stay awake long enough to complete my homework tonight?”

Fatigue is not a rare effect of endometriosis, and it may not just be due to the invisible planning and emotional work required to cope with this condition.

A study published in Human Reproduction in 2018 found that many women with endometriosis experience fatigue but that healthcare professionals rarely address or account for it.

One of the study authors, Prof. Brigitte Leeners, commented that their “findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease.”

“Although chronic fatigue is known to be one of the most debilitating symptoms of endometriosis, it is not widely discussed, and few large studies have investigated it,” she added.

Endometriosis can also cause severe abdominal pain during and after intercourse with vaginal penetration, which can put women off having sex or cause them anxiety about being intimate with their partners.

“One of the biggest effects of endometriosis has been its impact on my relationship and my sex life,” Lisa told MNT.

“Before surgery, sex was incredibly painful for me, and [my partner and I] were forced to completely abstain from sex for that reason,” she noted.

The impact of experiencing severe pain during sex for years is unrelenting, Lisa went on to tell us. “Even after surgery, I still experience a lot of pain and a lot of fear and anxiety regarding sex and the pain it can cause for me,” she admitted.

‘My family doctor mocked me’

Beyond its physical effects, perhaps the greatest impact endometriosis has is how it affects women’s ability to navigate the world freely and with confidence.

This is not just because they have to plan everything and prepare for the days they know they will have to spend in excruciating pain or experiencing serious and unsettling blood loss.

More than anything, women who live with endometriosis face the constant frustration of being misbelieved by their doctors, managers, teachers, and even family and friends, who often still think of this chronic condition in terms of “a bad period.”

“When I submitted my master’s thesis, I was in tremendous pain on the day of the deadline,” Alma recalled.

“I asked my [family doctor] for a doctor’s note, and he mocked me, repeating several times the phrase ‘you want a doctor’s note … for period pain. A doctor’s note … for … period pain,’ as if it was the most shocking thing he’d ever heard in his life, and how could I dare ask for such a thing.” – Alma

“Many people reach out to me and say their doctor doesn’t think they have [endometriosis], because their symptoms don’t fit the outdated profile of someone who just had bad cramps around their period,” Rishe told MNT.

“Another [misconception healthcare professionals have] is the belief that hysterectomy is a cure for endometriosis. By definition, endometriosis occurs when cells similar to the uterine lining end up outside of the uterus, in other parts of the body,” she went on to explain.

“[B]y definition, a hysterectomy wouldn’t cure endometriosis, since the [endometrial-like] cells are not in the uterus. Additionally, there are no studies to date that show hysterectomy treats endometriosis, yet it is still commonly recommended,” Rishe pointed out.

The women who spoke to MNT all emphasized the need for a better understanding of this condition. The general public needs to be better informed about the realities of endometriosis.

Family should also shed their misconceptions, they all told us. Employers and educators must pay attention, too.

“I wish employers knew how hard it is to live with such a condition, and accommodate their employees,” Alma told MNT.

“I wish employers, partners, etc., wouldn’t blame the person living with [endometriosis] for not having ‘planned’ better around it — this was a frequent thing I would get, the attitude of ‘Well, but you know you’re gonna have a period, and you won’t be able to do much during it, so why didn’t you plan better for said deadline.’” – Alma

‘We desperately need better treatment options’

The lack of satisfactory care for and research into endometriosis is also a major barrier for women living with this condition.

“We desperately need better treatment options,” Martha told MNT. “I have medical debt from pursuing treatment options that weren’t covered by my insurance, and sometimes those treatments didn’t even help,” she said.

Moreover, she added, “[s]ome of the most effective treatment options also come with the risk of severe and long-term side effects, so we often have to weigh whether it’s worth trying or not.”

“It’s also shocking to realize how few medical professionals actually have a working knowledge of endometriosis. […] A few times I went to the emergency room because of the pain, and nobody could help me.” – Martha

Research published in the American Journal of Obstetrics and Gynecology in 2019 emphasizes that women who seek care for endometriosis face a barrage of obstacles, including poor doctor-patient dynamics and a lack of effective treatments.

One of the study authors, Dr. Rebecca Nebel, straightforwardly confirmed that “[d]espite its significant burden on women, their families, and society as a whole, endometriosis is underfunded and under-researched, greatly limiting understanding of the disease and slowing much-needed innovation in diagnostic and treatment options.”

“What bothers me the most,” Lisa told MNT, “is that ‘reputable’ sources are still promoting definitions of endometriosis that are not correct. […] We cannot begin to effectively diagnose and treat a disease that we can’t even define correctly.”

“All medical professionals, not just minimally invasive gynecologic surgeons, need to be educated on endometriosis symptoms, diagnosis, and treatment,” she added.

“Doctors need to stop perpetuating the myth that painful periods are ‘normal’ and ‘part of being a woman.’ […] Mental health professionals need to be educated on the impact of endometriosis and its symptoms on the mental health of patients. The medical community as a whole must recognize that endometriosis does not just affect cisgender women and that the disease affects people of all genders.” – Lisa

A long and exhausting journey

The women who spoke to MNT noted that the perpetuation of myths and stereotypes about endometriosis, as well as the lack of satisfactory treatments, can independently impact quality of life.

For her part, Martha said: “I’ve experienced the mental and physical toll of the lack of information and treatment options, and I’ve seen it in others, too.”

“I’m part of some tight-knit endo communities online, and we’ve lost more than one friend to suicide and had too many others attempt to take their own lives,” she told us. “The impact is far more severe than what you’d expect from something that’s often just characterized as ‘bad periods,’ and it really shows how badly we need more help.”

Knowing they could be misbelieved by doctors may also discourage women from seeking a diagnosis and treatment in the first place.

Rishe commented that some might also be put off by the prospect of surgery.

“The fact that the only way to 100% diagnose [endometriosis] is via a laparoscopy surgery [may prevent some people from seeking a diagnosis]. Some may think that is too invasive of a procedure to go through,” she told us.

For those who do want to seek a diagnosis and treatment plan, the journey is likely to be long and difficult. Rishe had some suggestions as to how an individual could best advocate for their health.

“The best thing a person can do,” she said, “is do their research about the disease so that they have a good understanding to be able to ask the right questions and know when they may be in the best hands.”

She recommended some useful places online: “Some great resources with reliable information are The Endometriosis Coalition, Endo What?, the Center for Endometriosis Care, and The Endometriosis Summit.”

“The next [step] would be to try to see a doctor who specializes in endometriosis. These doctors have a higher level [of] understanding of the disease and are able to provide adequate treatment. I also always encourage people to keep a diary of their symptoms so that they have an accurate account of everything they’d like to explain to their doctor.”– Jenneh Rishe

The onus, however, should not fall on patients to research the mechanisms behind their condition, and potential treatments. Physicians and researchers have a responsibility to find the best path forward.

Society at large, however, has a responsibility, too: to stay informed and nurture empathy.

“The main thing that I’d like people to know is that pain that is so disruptive that you’re missing out on life, work, school, etc., is not normal,” said Rishe.

“As a society, we’ve normalized period-related pain, and I believe that makes people with suspected [endometriosis] feel [that] what they are dealing with is normal,” she added.

Our contributor Alma also had a heartfelt plea for her peers who do not live with endometriosis.

“[A] word of advice for fellow women or vagina bearers everywhere: please don’t tell women with endometriosis that you ‘also have very painful cramps.’ […] [O]ftentimes, pain for women living with endometriosis means you’re on the floor or in your bed, unable to move or do anything else but moan with pain,” she said, asking that each of us stop trivializing chronic pain.

* We have changed the names of these contributors to protect their identities.

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In a living systematic review and meta-analysis in The BMJ, scientists from the United Kingdom, along with international collaborators, continue to collate and analyze emerging evidence of how COVID-19 affects women and their babies during and shortly after pregnancy.

In the latest update, the team confirms that pregnant women attending or admitted to the hospital from whatever cause continue to be at a greater risk of severe COVID-19 than nonpregnant women of similar ages.

Preexisting diabetes, chronic hypertension, asthma, smoking, gestational diabetes, preeclampsia, being aged 35 years or over, and having a body mass index (BMI) of 30 or above were all associated with greater odds of severe COVID-19 and requiring admission to the intensive care unit (ICU).

Nonwhite ethnicity was linked with a greater likelihood of ICU admission, but not necessarily with severe COVID-19.

Meanwhile, babies of mothers with COVID-19 were more likely to require admission to the neonatal intensive care unit (NICU). The authors note that this could be due to hospital policies for observation and quarantine of babies in contact with COVID-19.

Dr. John Allotey, the study’s first author and a lecturer in epidemiology and women’s health at the World Health Organization (WHO) Collaborating Centre for Global Women’s Health at the University of Birmingham in the U.K., comments: “Pregnant women should be considered a high risk group, particularly those identified to have risk factors, for severe COVID-19 based on our findings.”

“Mothers should also be reassured that the risks to their babies are very low,” he continues.

Reviewing the evidence

The research team started work on the review in April 2020. For its first iteration, they collated data from available publications between December 2019 and June 2020.

Each week, the researchers looked for newly published data, which they aimed to review every 2–4 months. For the recent update, they added new studies published up until October 2020.

The review now includes data from 192 studies and 29 different countries. Of these studies, 115 were new editions to the latest update.

Overall, the data show that 10% of pregnant women who are either admitted to the hospital or visiting the hospital receive a positive SARS-CoV-2 test.

Pregnant women are more likely than nonpregnant women to have an asymptomatic SARS-CoV-2 infection.

However, the reason for this may lie in the strategy for testing.

Pregnant people routinely undergo COVID-19 testing when they attend hospital appointments, while nonpregnant individuals most likely have a test when they experience symptoms.

“[The] true prevalence of [COVID-19] in pregnancy is likely to be lower than the current estimate if all pregnant women, including those not attending the hospital, are included,” the authors comment in the paper.

While the risk of severe COVID-19 was greater for pregnant women than for nonpregnant women overall, there were specific risk factors that the team identified.

These include age, BMI, preexisting conditions, as well as conditions developed during pregnancy.

The researchers found that pregnant women or those who had recently given birth were more likely to die if they had COVID-19 than those who were the same age but not pregnant. In addition, the rates of premature birth and stillbirth were higher for women with the disease.

However, the team caveat that the premature births are likely to be the result of medical decisions to induce early delivery in those with COVID-19 as the number of spontaneous preterm births was the same as baseline levels. The number of stillbirths across all of the studies included in the review was very small (9 out of 5,794 women with COVID-19).

More data needed

One further issue that this review found is that women who were of nonwhite ethnicity were more likely to require admission to the ICU for COVID-19 treatment.

There was a link between nonwhite ethnicity and a greater likelihood of ICU admission, based on four studies covering 31,456 individuals. Four smaller studies covering 2,263 women suggested that nonwhite ethnicity may result in having a 6% lower chance of severe disease. However, this figure could vary between 43% less likely and 57% more likely.

Other studies have previously found disparities in maternal outcomes between people of different ethnicities.

“The observed disparity could be attributed to associated comorbidities, socioeconomic characteristics, and factors related to access to and quality of care in the preconception, pregnancy, and postpartum periods,” the review’s authors write in their discussion. “The multifaceted contributors to ethnic disparities need to be investigated to reduce mortality and morbidity related to both [COVID-19] and pregnancy.”

The team highlights several limitations of their review, including the fact that the studies included in the analysis did not use the same methods to collect and gather data. This is an issue that all systematic reviews face.

Senior study author Professor Shakila Thangaratinam, who is the Co-Director of the WHO Collaborating Centre for Global Women’s Health, comments on the team’s finding:

“In the current situation, where evidence is rapidly produced, our living systematic review — underpinned by robust methods and continually updated at regular intervals — is crucial to address important research questions and to shape healthcare policy and clinical decision-making.”

“Pregnant women and healthcare professionals will need to take into account the additional risks faced by pregnant women with COVID-19 in making decisions, such as taking-up of vaccines if offered to prevent COVID-19 and plan management in pregnancy.” – Prof. Shakila Thangaratinam

The Centers for Disease Control and Prevention (CDC) additionally state that “[a]lthough the overall risk of severe illness is low, pregnant people are at an increased risk for severe illness from COVID-19 when compared to nonpregnant people.”

They advise nonpharmaceutical interventions, such as mask wearing, physical distancing, avoiding crowds, and limiting contact with people who may have been exposed to the SARS-CoV-2 virus to reduce the risk of developing COVID-19.

The CDC also suggest having a COVID-19 vaccine when it is available to pregnant people and speaking with a healthcare professional about any questions or concerns.

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Humans first drank caffeinated tea more than 4,000 years ago in China. Since then, it has become one of the most popular drinks worldwide, second only to water.

Both green and black teas are brewed from the leaves of the same shrub, Camellia sinensis, but green tea, which is made from unfermented leaves, contains more antioxidants.

Oxidation during the fermentation process of black tea reduces its antioxidant levels.

Several studies have found that green tea inhibits the formation of cancers, lowers high blood pressure, and reduces the risk of heart disease.

However, the molecular mechanism responsible for the effect on blood pressure has been unclear until now.

Scientists at the University of California, Irvine (UCI) and the University of Copenhagen, in Denmark, have found that antioxidants in tea open ion channels and can relax the muscles that line blood vessels.

They report their findings in the journal Cellular Physiology & Biochemistry.

Preventable risk factor

The discovery could guide the design of more effective antihypertensive drugs, which could potentially improve the health of millions of people around the world.

According to the National Heart, Lung, and Blood Institute, controlling or lowering high blood pressure can help prevent chronic kidney disease, heart attacks, heart failure, and possibly dementia.

The Centers for Disease Control and Prevention (CDC) report that almost half of all adults in the United States have hypertension. It estimates that in 2018, the condition played a role in the deaths of nearly half a million people in the country.

The World Health Organization (WHO), meanwhile, estimate that more than 1 billion people worldwide have hypertension.

The new study first shows that two antioxidants in tea, known as catechins, open a protein channel in the membranes of the smooth muscle cells that line blood vessels. This allows positively charged potassium ions to leave the cells.

Channels in nerve and muscle cells maintain voltages across their membranes by allowing negative and positive ions to pass in and out in a controlled way. They are “voltage-gated,” which means that they respond to changes in this voltage by opening or closing.

The researchers found that the catechins in green tea activate a particular type of potassium ion channel, called KCNQ5.

Previous work by some of the same scientists suggests that this protein channel may underlie the antihypertensive effects of several plants used as folk medicines for millennia.

Voltage sensor

For the new study, the researchers used computer modeling and mutated versions of the channel protein to show that the two catechins bind to a section that senses voltage changes.

“This binding allows the channel to open much more easily and earlier in the cellular excitation process,” explains senior study author Prof. Geoffrey Abbott, of the Department of Physiology & Biophysics at the UCI School of Medicine.

In theory, this should make the muscle cells less “excitable” and therefore less likely to contract. They should instead relax, dilating the blood vessel and reducing blood pressure.

To test this theory, Prof. Abbott’s co-authors at the University of Copenhagen measured changes in tension in the walls of arteries from rats. Their findings confirmed that the two catechins from tea relax and dilate arteries by activating the KCNQ5 ion channel.

Milky tea

The authors are confident that adding a dash of milk to black tea does not reduce its antihypertensive effects.

Milky tea, applied directly to cells in the lab, failed to activate their KCNQ5 channels. But this is likely not the case when a person drinks it.

Prof. Abbott explains:

“We don’t believe this means one needs to avoid milk when drinking tea to take advantage of the beneficial properties of tea. We are confident that the environment in the human stomach will separate the catechins from the proteins and other molecules in milk that would otherwise block [the] catechins’ beneficial effects.”

The scientists also discovered that warming green tea to 35°C increased the activation of KCNQ5.

However, lovers of iced tea need not be concerned.

“Regardless of whether tea is consumed iced or hot, this temperature is achieved after tea is drunk, as human body temperature is about 37°C,” says Prof. Abbott. “Thus, simply by drinking tea, we activate its beneficial, antihypertensive properties.”

Electrical activity in the brain

KCNQ5 also exists in the membranes of nerves in the brain, where it helps regulate electrical activity and signal transmission.

People with a disorder called epileptic encephalopathy have a version of the channel protein that does not respond effectively to voltage changes, which leads to frequent seizures.

The study authors point out that catechins can cross the blood-brain barrier, which prevents larger molecules, including some drugs, from entering the brain.

In theory, drugs modeled on catechin molecules could, therefore, help correct the cause of epileptic encephalopathy.

“Discovery of their ability to activate KCNQ5 may suggest a future mechanism to fix broken KCNQ5 channels to ameliorate brain excitability disorders stemming from their dysfunction,” the researchers conclude.

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For many decades, nutritionists have recommended a balanced diet to provide the body with the proper nutrients to stay healthy. The core components of this diet include vegetables, fruits, grains, proteins, and dairy.

A recent study by researchers at the Harvard T. H. Chan School of Public Health in Boston, MA, provides further evidence for current dietary guidelines and expands on them, finding that consuming at least 2 fruit and 3 vegetable servings on a daily basis may lower the risk of both disease-related death and death from all causes.

The study appears in Circulation, a scientific journal of the American Heart Association (AHA).

Current dietary guidelines

“While groups like the American Heart Association recommend 4–5 servings each of fruits and vegetables daily, consumers likely get inconsistent messages about […] the recommended amount and which foods to include and avoid,” says Dr. Dong D. Wang, M.D., Sc.D., an epidemiologist and nutritionist at Harvard Medical School and lead author of the study.

The Department of Health and Human Services and the Department of Agriculture published their recommendations in the form of the 2020–2025 Dietary Guidelines for Americans.

According to this set of guidelines, half of the plate for every meal should contain fruits and vegetables.

However, the guidelines also note that more than 80% of people in the United States do not meet this recommendation and should aim to increase their consumption of nutrient-dense foods.

Participant dietary information

The researchers collected self-reported dietary information from two large cohort studies: the Nurses’ Health Study (NHS) and the Health Professionals’ Follow-up Study (HPFS).

The NHS cohort included registered female nurses between the ages of 30 and 55 years, while the HPFS cohort included males aged 40–75 years with occupations in the health profession. These studies included follow-ups with the participants every 2–4 years to accumulate dietary information over a span of approximately 30 years.

The researchers excluded participants with baseline heart disease, cancer, or diabetes, leaving them with data from 66,719 females and 42,016 males.

They also incorporated data from an additional 26 studies involving a total of 1.9 million participants, which examined the relationship between fruit and vegetable intake and death rates.

The high participant numbers and continuous longitudinal assessments provided the team with an extensive collection of data for analysis.

However, it is important to note that the criteria of the two cohorts — occupation and corresponding education — suggest a similar socioeconomic status across the participants, who may have been more likely than other members of the population to have access to a healthy diet. The study does not address the realities and effects of food insecurity.

Nutritional values of fruits and vegetables lower risk of death

The study outcomes showed that an increased intake of fruits and vegetables is associated with a lower risk of death, including death due to cancer, heart disease, or respiratory disease.

Additionally, the researchers saw the lowest risk of death at a threshold of a combined 5 servings, beyond which there was no apparent benefit on risk.

These results point to the nutritional value of these foods. For example, higher consumption of fruits and vegetables increases the intake of potassium and antioxidant activity, which link to lower blood pressure and improved lung function, respectively.

As the data are fully self-reported, there may be discrepancies between the actual and reported intakes. Participants with higher intake, in particular, may have tended to overestimate how many servings they consumed.

This margin of error may blur the defined threshold of 5 servings, so the study authors acknowledge that slightly higher servings (up to 10) could also lead to lowered risk.

This study also expands beyond current guidelines by differentiating among specific groups of fruits and vegetables.

The researchers observed trends with a lowered risk of death for leafy greens and foods rich in vitamin C and beta carotene. Fruits and vegetables that fall into these categories include spinach, kale, carrots, and citrus fruits.

Conversely, they did not identify any trends for fruit juices or starchy vegetables, such as potatoes and peas. One possible reason for the latter is the prominence of canned foods. The canning process may deprive starchy vegetables of their antioxidant properties.

Compared with whole fruits, the fluid form of juices may cause a more rapid elevation of blood glucose and insulin levels, which can increase the risk of disease.

In contrast to the existing guidelines, which include canned foods and juices among the recommended foods and drinks, this study calls for further research on the effects of these items on health.

Continued support for ‘5-a-day’ serving recommendation

Rather than being an interventional study, in which researchers directly implement variables and analyze the effects, this study was observational. As a result, it is not possible to conclude that the trends present in this study indicate a causal relationship.

Regardless, there is plentiful evidence that highlights the benefits of a balanced diet containing plenty of fruits and vegetables. The present conclusions also correspond to findings from similar observational studies on the associations between fruit and vegetable intake and disease.

The findings of this study conform to the overall current dietary guidelines to eat at least 5 servings of fruits and vegetables a day. Additionally, it provides further insight into the specificities and benefits of fruit and vegetable intake.

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Developed in Israel, where it has been available for eight years, Vigore treatment is said not only to assist men with erectile dysfunction (ED) but also to help those who are just not as good as they were in their 20s and 30s.

The treatment normally involves four blasts of sound waves lasting about five minutes each, with an interval of one week between each session. The idea is that the sound waves kick-start the growth of new blood vessels, which boosts blood supply and so improves, reduced erections.

Some studies suggest there is a benefit. One, carried out by researchers in Spain, and published in the World Journal Of Urology in July, looked at 76 men with erectile dysfunction who had failed to improve on drugs such as sildenafil (Viagra), taken just before intercourse, or tadalafil, a similar, but daily, tablet.

Shockwave treatment, such as Vigore, involves a doctor passing a wand-like device along the penis while it emits gentle pulses for 15 to 20 minutes. This stimulates the growth of new blood vessels to increase blood supply to the penis and is also thought to promote the release of nitric oxide, which helps dilate blood vessels.

Meanwhile, scientists say a quick blast with a laser can boost a woman’s sex drive. Experts found a painless five-minute zap increased libido and the number of orgasms.

The “fractional CO2 laser” involves rotating the device in the vagina, sending pulses of heat to tissue. It causes tiny wounds that trigger collagen production and boost blood flow.

The study, in 50 older women, compared regular hormonal cream with three laser sessions, which cost from £1,000.

It found sexual desire soared by 45 per cent and arousal by 56 per cent with the laser. The cream scores only went up 30 per cent and 27 per cent.

Post-laser satisfaction also rose by 40 per cent, with orgasms up 46 per cent, reported the Journal of Lasers in Medical Sciences.

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Although antianxiety medications target the nervous system, one new study suggests that anxiety disorders may stem more from the endocrine system.

Most people have brief periods of anxiety from time to time, such as when they experience stressful situations in which the outcome is unknown.

For many individuals, however, anxiety is an acute, frequent, and persistent emotional state that adversely affects quality of life. In fact, experts estimate that anxiety disorders affect around 264 million people worldwide.

Antianxiety medications, which typically target the central nervous system, can be helpful, but they often fail to provide permanent relief.

Now, a new study suggests that anxiety disorders may stem, at least in part, from malfunctions in the body’s endocrine system.

The results demonstrate that inflammation of the thyroid gland is associated with anxiety disorders, suggesting new avenues of treatment.

The researchers presented their findings at the European and International Conference on Obesity in September 2020. Juliya Onofriichuk, from Kyiv City Clinical Hospital in Ukraine, led the research.

She explains: “These findings indicate that the endocrine system may play an important role in anxiety. Doctors should also consider the thyroid gland and the rest of the endocrine system, as well as the nervous system, when examining [people] with anxiety.”

The thyroid gland

The thyroid gland produces two important hormones — T4 (thyroxine) and T3 (triiodothyronine) — that are involved in maintaining heart and muscle function, digestion, brain development, and bone health.

T4 and T3 help produce and regulate the hormones adrenaline and dopamine.

Adrenaline is sometimes known as the fight-or-flight hormone. It is associated with a sudden burst of energy, such as that which occurs in response to a threat.

Dopamine is the brain’s pleasure and reward hormone, and too much (or too little) of it can affect a person’s sense of well-being and quality of judgment.

Inflammation of the thyroid gland typically occurs when the body mistakenly targets the gland as an unwelcome invader. When this occurs, the body produces antibodies that attack the gland. These antibodies may damage the thyroid and can cause it to malfunction.

The study

Onofriichuk and colleagues studied 29 men and 27 women. Their average ages were 33.9 years and 31.7 years, respectively. Doctors had diagnosed anxiety in these individuals, and they all experienced anxiety attacks.

The scientists examined the participants’ thyroid glands using ultrasound. They also measured their levels of T4 and T3.

The researchers found that the thyroids of people with anxiety disorders exhibited signs of inflammation. They also detected thyroid antibodies in these individuals.

Even though the participants’ thyroid glands were inflamed, they were not significantly malfunctioning. Their T4 and T3 levels were slightly elevated but remained within a normal range.

To treat the inflammation, the researchers gave the participants a 14-day course of ibuprofen and thyroxine. This treatment successfully reduced thyroid inflammation.

Once the inflammation had resolved, the individuals experienced lower levels of anxiety, according to tests that the researchers carried out.

The implications of the study

The researchers did not investigate the role of sex and adrenal gland hormones in anxiety, though other research has noted the possible influence of the latter. Even so, the team’s findings offer new hope for people with anxiety.

Anxiety treatments may be more effective when they take into account the role of the endocrine system. The new study suggests that anxiety is not exclusively a disorder of the central nervous system.

It is worth noting that, to date, this particular study has not undergone peer review and does not appear in a medical journal.

Also, the study was relatively small, so scientists will need to replicate the findings in large-scale, placebo-controlled studies before drawing any solid conclusions.

Next up for the researchers is a wider investigation of the endocrine system’s role in anxiety disorders. They plan to explore the influence of sex and adrenal gland hormones — including estrogen, testosterone, cortisol, progesterone, and prolactin — in people with diagnosed anxiety disorders and inflamed thyroid glands.

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Beer bellies really do lead to brewer’s droop, research reveals.

Nine in ten middle-aged men with waists greater than 40in struggle to get an erection. The rate was a quarter higher than those with a 37in gut, who tended to have only mild difficulties. Those with the biggest bellies had nearly a quarter fewer orgasms and were less sexually satisfied.

Excess belly fat reduces the flow of blood needed to perform and affects testosterone levels, the Turkish researchers suggest in the Journal of Sexual Medicine.

Prof. Mustafa Bolat said: “It is similar to the furring up of arteries that occurs in heart disease.”Commenting on the findings, sex therapist Phillip Hodson said: “The greater British beer belly is not only bad for your heart physically – it is now clearly been linked to not being able to start, continue or complete the act of love.

“Belly fat also converts testosterone to oestrogen thus interfering with proper hormonal balance.

“Many try to disguise their girth by not tucking in shirts. But they’d do better to heed Government advice and not tucking into booze and butties.”

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