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New study finds epilepsy drug could reduce sleep apnoea symptoms

New research has found that a drug used for epilepsy could be used to reduce the symptoms of sleep apnoea. Obstructive sleep apnoea, which affects about one in 20 people, according to the National Institute for Health and Care Excellence in England, includes symptoms like snoring and it causes a person's breathing to start and stop during the night, with many requiring an aid to help keep their airways open. An international study has identified that taking sulthiame, a drug sold under the brand name Ospolot in Europe, may help prevent patients' breathing from temporarily stopping. This provides an additional option for those unable to use mechanical breathing aids like the Cpap machines. “The standard treatment for obstructive sleep apnoea is sleeping with a machine that blows air through a face mask to keep the airways open. Unfortunately, many people find these machines hard to use over the long term, so there is a need to find alternative treatments,” Prof Jan Hedner from Sahlgrenska university hospital and the University of Gothenburg in Sweden said. Researchers conducted a randomised controlled trial of almost 300 obstructive sleep apnoea patients across Europe, who did not use Cpap machines. They were divided into four groups and given either a placebo or different strengths of sulthiame. The study measured patients’ breathing, oxygen levels, heart rhythm, eye movements, as well as brain and muscle activity while asleep. It found after 12 weeks, those taking sulthiame had up to 50% fewer occasions where their breathing stopped, and higher levels of oxygen in their blood. However, a bigger study needs to be done to confirm the beneficial effects on a larger group. The findings, were presented at the European Respiratory Society Congress in Vienna, Austria. Erika Radford, the head of health advice at Asthma + Lung UK said the findings were a positive step forward in moving away from having to rely on mechanical breathing equipment. “This potential alternative to the current main treatment would make it easier for people to manage their condition,” she said. Image: Shutterstock

Body

Ovarian cancer is hard to detect. Focusing on these 4 symptoms can help with diagnosis

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Ovarian cancers are often found when they are already advanced and hard to treat. Researchers <a href="https://ascopubs.org/doi/10.1200/JCO.2010.32.2164">have long believed</a> this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be <a href="https://cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-ovarian-cancer">hard to identify</a> as they’re vague and similar to other conditions. But <a href="https://ijgc.bmj.com/content/early/2024/07/24/ijgc-2024-005371">a new study</a> shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist. As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages. So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly? <h2>Why is ovarian cancer hard to detect early?</h2> Ovarian cancer <a href="https://pubmed.ncbi.nlm.nih.gov/24979449/">cannot be detected</a> via cervical cancer screening (which used to be called a pap smear) and pelvic exams <a href="https://pubmed.ncbi.nlm.nih.gov/24979449/">aren’t useful</a> as a screening test. Current <a href="https://www.canceraustralia.gov.au/cancer-types/gynaecological-cancers/clinicians-hub/ovarian-cancer-guidelines">Australian guidelines</a> recommend women get tested for ovarian cancer if they have symptoms for <a href="https://www.canceraustralia.gov.au/sites/default/files/publications/assessment-symptoms-may-be-ovarian-cancer-guide-gps/pdf/ocg_assessment_of_symptoms_gp_card_0.pdf">more than a month</a>. But many of the <a href="https://cancer.org.au/cancer-information/types-of-cancer/ovarian-cancer">symptoms</a> – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses. This makes early detection a challenge. But it is crucial – a woman’s <a href="https://seer.cancer.gov/statfacts/html/ovary.html">chances of surviving ovarian cancer</a> are associated with how advanced the cancer is when she is diagnosed. If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has <a href="https://seer.cancer.gov/statfacts/html/ovary.html">already metastatised</a>, meaning it has spread to other parts of the body. If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%. There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women <a href="https://pubmed.ncbi.nlm.nih.gov/37183782/">failed to reduce deaths</a>. That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly. <h2>What did the new study look at?</h2> Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK. They were asked to monitor for these four symptoms: <ul> <li>persistent abdominal distension (women often refer to this as bloating)</li> <li>feeling full shortly after starting to eat and/or loss of appetite</li> <li>pelvic or abdominal pain (which can feel like indigestion)</li> <li>needing to urinate urgently or more often.</li> </ul> Women who reported at least one of four symptoms persistently or frequently were put on a <a href="https://pubmed.ncbi.nlm.nih.gov/22479719/">fast-track pathway</a>. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines. Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound. <h2>What did they find?</h2> The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer. A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths. Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body. There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%). It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body. <h2>What does this mean for detection?</h2> The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates. It also points to the importance of public awareness about symptoms. Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue. But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought. This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient. Many women remain <a href="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/24612526/&sa=D&source=docs&ust=1723610085733806&usg=AOvVaw3J5o5DwRFiDzFaQcD7VTQn">unaware of the symptoms</a> of ovarian cancer. This study shows recognising them may help early detection and treatment.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236775/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, Clinical Professorial Research Fellow, Australian Women and Girls' Health Research Centre, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ovarian-cancer-is-hard-to-detect-focusing-on-these-4-symptoms-can-help-with-diagnosis-236775">original article</a>. </div>

Body

Is it really possible to have Alzheimer’s yet no symptoms?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/michael-hornberger-1507154">Michael Hornberger</a>, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> Some people seem to be more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003087/#:%7E:text=Some%20individuals%20are%20able%20to,into%20a%20widely%20debated%20concept.">resilient</a> to developing Alzheimer’s diseases, despite having the biological hallmarks of the devastating disease. For obvious reasons, scientists are very interested in studying this special group of people. Alzheimer’s disease, the most common form of dementia, is thought to start because of a build-up of two proteins in the brain: amyloid and tau. Once these proteins accumulate, for yet-to-be-determined reasons, they become toxic to brain cells (neurons) and these cells start dying. As a result, people develop symptoms such as memory loss because the brain can’t function properly with all these dead neurons. This cascade of events has been known for many years and is how the disease progresses in most people with Alzheimer’s. Most people, except a special group who are more resilient. But why are they resilient? A recent study in the journal <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-024-01760-9">Acta Neuropathologica Communications</a> investigated whether our genes might influence how resilient we are against Alzheimer’s disease symptoms when there are high levels of amyloid in our brain. The scientists conducted a study on the brains of three groups of people. The first group comprised people who had died with Alzheimer’s disease. The second were healthy people who died of natural causes. And the third comprised people who had high levels of Alzheimer’s proteins in the brain but never developed symptoms of the disease during their lifetime – or at least never had a diagnosis of Alzheimer’s disease. The last group, they considered as being resilient to Alzheimer’s disease since they had the proteins in their brains but did not have the symptoms or a diagnosis of Alzheimer’s disease during their lifetime. The scientists found that genes related to the activity of the immune system seem to have been more active in the Alzheimer’s resilient group. This would make sense as it is well established that the immune system helps clear the excess proteins from the brain, so genes that help this process might make us more resilient to developing symptoms of the disease. <h2>How to become resilient – even if you don’t have the genes</h2> This is great if you have inherited these genes from your parents, but what does it mean for the rest of us who do not have those genes? Is there a way we can make ourselves more resilient to developing Alzheimer’s disease regardless of our genes? “Yes” is the short answer. There is now good scientific evidence that <a href="https://theconversation.com/can-alzheimers-really-be-reversed-as-a-new-documentary-claims-230705">lifestyle changes</a> and drugs allow us to reduce our risk of developing Alzheimer’s disease in the future. In particular, physical activity has been shown to reduce our risk of developing Alzheimer’s, probably because it has a well-known beneficial effect on our immune system and hence helps clear those rogue proteins accumulating in our brains. This means that being more physically active might have the same effect on our Alzheimer’s resilience as those lucky people who have the “right” genes. Interestingly, we do not know how physically active the resilient people in the study were and how this might have influenced their resilience to Alzheimer’s disease. As so often in science, it is not clear whether nature (genes) or nurture (lifestyle) contributed to their resilience. The other interesting aspect is that the resilient people in the study died of another cause than Alzheimer’s disease, but they might have developed Alzheimer’s disease eventually if they had lived longer.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230334/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-hornberger-1507154">Michael Hornberger</a>, Professor of Applied Dementia Research, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/is-it-really-possible-to-have-alzheimers-yet-no-symptoms-230334">original article</a>. </div>

Mind

How tracking menopause symptoms can give women more control over their health

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them. People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important. <a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry. There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” <h2>Why does monitoring symptoms help?</h2> One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms. Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209004/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">original article</a>. </div>

Body

Silent cancers: here’s what you need to know when there are no obvious symptoms

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

Body

What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

How do stimulants actually work to reduce ADHD symptoms?

<a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Stimulants are <a href="https://adhdguideline.aadpa.com.au/">first-line drugs</a> for children and adults diagnosed with attention-deficit hyperactivity disorder (ADHD). But how do they actually work? <h2>First, let’s look at the brain</h2> ADHD is a neurodevelopmental condition, which means it affects how the brain functions. Medical imaging indicates people with ADHD may have slight differences in their brain’s <a href="https://jamanetwork.com/journals/jama/article-abstract/195386">structure</a>, the way their brain regions work together to perform tasks, and how their brain’s chemical messengers, called neurotransmitters, pass on information. These brain differences are associated with the symptoms of ADHD, including inattention, impulse control and problems with memory. <h2>What stimulants are prescribed in Australia?</h2> The three main stimulants prescribed for ADHD in Australia are dexamfetamine, methylphenidate (sold under the brand names Ritalin and Concerta) and lisdexamfetamine (sold as Vyvanse). Dexamfetamine and methylphenidate have been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194/">since</a> the 1930s and 1940s respectively. Lisdexamfetamine is a newer stimulant that has been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">since</a> the late 2000s. Dexamfetamine and lisdexamfetamine are amphetamines. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">Lisdexamfetamine</a> is inactive when it’s taken and actually changes into active dexamfetamine in the red blood cells. This is what’s known as a “prodrug”. <h2>So how do they work for ADHD?</h2> Stimulant drugs are thought to alter the activity of key neuotransmitters, dopamine and noradrenaline, in the brain. These neurotransmitters help with attention and focus, among other things. Stimulants increase the amount of dopamine and noradrenaline in the tiny gaps between neurons, known as synapses. They do this by predominantly blocking a transporter that then prevents their re-uptake back into the neuron that released them. This means more dopamine and noradrenaline can bind to their respective receptors. This <a href="https://www.tga.gov.au/sites/default/files/auspar-lisdexamfetamine-dimesilate-180515-pi.pdf">helps</a> connected neurons in the brain talk to one another. Amphetamines also increase the amount of dopamine the neuron releases into the synapse (the tiny gaps between neurons). And it stops the enzymes that break down dopamine. This results in an increase of dopamine in the synapse. <h2>What effect do they have on ADHD symptoms?</h2> We still don’t fully understand the underlying brain mechanisms that change behaviour in people with ADHD. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109107/">research shows</a> stimulants that modulate noradrenaline and dopamine can improve brain processes such as: <ul> <li>attention</li> <li>memory</li> <li>decision-making</li> <li>task completion</li> <li>hyperactivity.</li> </ul> They can also improve general behaviour, such as self-control, not talking over the top of others, and concentration. These behaviours are important for social interactions. Stimulants <a href="https://pubmed.ncbi.nlm.nih.gov/15737659/">reduce ADHD symptoms</a> in about 70% to 80% of children and adults who take them. Some people will notice their symptoms improve right away. Other times, these improvements will be more noticeable to parents, carers, teachers, colleagues and partners. <h2>Not everyone gets the same dose</h2> The optimal stimulant dose varies between individuals, with multiple dosage options available. This enables a “start low, go slow” approach, where the stimulant can be gradually increased to the most effective dose for the individual. There are also different delivery options. Dexamfetamine and methylphenidate are available in immediate-release preparations. As these have short half-lives (meaning they act quickly and wear off rapidly), they are often taken multiple times a day – usually in the morning, lunch and afternoon. Methylphenidate is also <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03175-3&d=20231023172310101">available</a> in long-acting tablets (Concerta) and capsules (Ritalin LA). They are released into the body over the day. Lisdexamfetamine is a long-acting drug and is not available in a short-acting formulation. The long-acting stimulants are generally taken once in the morning. This avoids the need to take tablets during school or work hours (and the need to store a “controlled drug”, which has the potential for abuse, outside the home). <h2>What are the side effects?</h2> The most common side effects are sleep problems and decreased appetite. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012069.pub2/full">recent study</a> showed children and young people taking methylphenidate for ADHD were around 2.6 times more likely to have sleep problems and 15 times more likely to have a decreased appetite than those not taking methylphenidate. Headache and abdominal pain are also relatively common. <h2>Can someone without ADHD take a stimulant to improve productivity?</h2> Stimulants are tightly controlled because of their potential for abuse. In Australia, only paediatricians, psychiatrists or neurologists (and GPs in special circumstances) can prescribe them. This follows a long assessment process. As stimulants increase dopamine, they can cause euphoria and a heightened sense of wellbeing. They can also cause <a href="https://www.ncbi.nlm.nih.gov/books/NBK576548/#:%7E:text=The%20immediate%20psychological%20effects%20of,and%20may%20result%20in%20insomnia.">weight loss</a>. A common myth about stimulant medicines is they can improve the concentration and productivity of people without ADHD. A <a href="https://www.science.org/doi/full/10.1126/sciadv.add4165">recent study shows</a> the opposite is true. This study gave a group of 40 people online arithmetic tasks to complete across four sessions. At each of the sessions, participants were given either a placebo or a stimulant before completing the task. The results showed that while stimulants did not impact getting the correct answer, it increased the number of moves and time to solve the problems compared to a placebo. This indicates a reduction in productivity. However, the myth that stimulants improve study prevails. It’s likely that users feel different – after all, they are taking a medicine that speeds up messages between the brain and body. It may make them “feel” more alert and productive, even if they’re not.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-stimulants-actually-work-to-reduce-adhd-symptoms-215801">original article</a>.

Mind

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

<a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Menopause is the stage of life where the ovaries stop releasing eggs and menstrual periods cease. Most Australian women go through menopause between <a href="https://www.nature.com/articles/nrdp20154">45 and 55</a> years of age, with the average age being 51 years, although some women may be younger. Hot flushes and night sweats are <a href="https://www.nature.com/articles/nrendo.2017.180">typical symptoms</a> of menopause, with vaginal dryness, muscle and joint pains, mood changes and sleep disturbance also commonly reported. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">75% of women</a> experience menopausal symptoms, with nearly 30% severely affected. These symptoms can negatively impact day-to-day life and wellbeing. The main therapies available include menopausal hormone therapy (MHT) and non-hormonal prescription therapy. Some women will elect to try complementary and alternative medicines, such as herbal medicines and nutritional supplements. Black cohosh is one of them. <h2>What causes hot flushes</h2> The cause of hormonal hot flushes (also called hot flashes) still isn’t completely understood, but the decline in oestrogen at menopause appears to play a role in a process that involves the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833827/">area of the brain that regulates temperature</a> (the hypothalamus). Factors linked to a greater likelihood of hot flushes include <a href="https://pubmed.ncbi.nlm.nih.gov/19675142/">being overweight or having obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">smoking</a>. MHT, previously known as hormone replacement therapy (HRT), usually includes oestrogen and is the <a href="https://pubmed.ncbi.nlm.nih.gov/26444994/">most effective treatment</a> for menopausal symptoms, such as hot flushes. But women may choose complementary and alternative medicines instead – either because they shouldn’t take hormone therapy, for example because they have breast cancer, or because of personal preference. Close <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">to 40%</a> of Australian women report using complementary and alternative medicines for menopausal symptoms, and up to 20% using them specifically to treat hot flushes and sweats. <h2>A long history</h2> Complementary and alternative medicines have a long history of use in many cultures. Today, their potential benefits for menopausal symptoms are promoted by the companies that make and sell them. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/">complementary and alternative medicines</a> women often try for menopausal symptoms include phytoestrogens, wild yam, dong quai, ginseng and black cohosh. Black cohosh (plant name Cimicifuga racemosa) was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">traditionally</a> used by Native Americans to treat a variety of health concerns such as sore throat, kidney trouble, musculoskeletal pain and menstrual problems. It is now a popular herbal choice for hot flushes and night sweats, as well as vaginal dryness and mood changes. There are <a href="https://pubmed.ncbi.nlm.nih.gov/37252752/">many theories</a> for how the active ingredients in black cohosh might work in the body, such as acting like oestrogen, or affecting chemical pathways in the brain. But despite extensive research, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">evidence to support these theories remains inconclusive</a>. It is also not clear whether black cohosh is effective for hot flushes. Results from individual studies are mixed, with <a href="https://pubmed.ncbi.nlm.nih.gov/17565936/">some</a> finding black cohosh improves hot flushes, while <a href="https://pubmed.ncbi.nlm.nih.gov/18257142/">others</a> have found it doesn’t. A 2012 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">review</a> combined all the results from studies of menopausal women using black cohosh to that date and found overall there was no proof black cohosh reduces hot flushes more effectively than an inactive treatment (placebo). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">This review</a> also revealed that many studies did not use rigorous research methods, so the findings are hard to interpret. A more recent <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review</a> of clinical trials claimed black cohosh may ease menopausal symptoms, but the included studies were mostly small, less than six months long, and included women with mild symptoms. There is also no meaningful evidence black cohosh helps other symptoms of menopause, such as vaginal symptoms, sexual problems, or poor general wellbeing, or that it protects against bone loss. Evidence for how black cohosh is absorbed and metabolised by the body is also lacking, and it is not known what dose or formulation is best to use. More good quality studies are needed to decide whether black cohosh works for hot flushes and other menopausal symptoms. <h2>Is it safe to try?</h2> A <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review of studies</a> suggests black cohosh is safe to use, although many of the studies have not reported possible adverse reactions in detail. Side effects such as gastrointestinal upset and rashes may occur. While there have been <a href="https://www.mja.com.au/journal/2008/188/7/liver-failure-associated-use-black-cohosh-menopausal-symptoms#0_i1091948">rare reports of liver damage</a>, there is <a href="https://pubmed.ncbi.nlm.nih.gov/21228727/">no clear evidence</a> black cohosh was the cause. Even so, in Australia, black cohosh manufacturers and suppliers are required to put a warning label for the potential of harm to the liver on their products. It is recommended black cohosh is not used by women with menopausal symptoms <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes/menopause/treatments-menopausal-symptoms">after breast cancer</a>, as its safety after breast cancer is uncertain. All women should consult with their doctor before using black cohosh if they are taking other medications in case of possible drug interactions. Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo. Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211272/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, Research fellow, Chronic Disease & Ageing, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272">original article</a>.

Body

How do hay fever treatments actually work? And what’s best for my symptoms?

<a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Spring has sprung and many people are welcoming longer days and more time outdoors. But for <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">almost one in five Australians</a>, spring also brings the misery of watery, itchy red eyes, a runny, congested nose, and sneezing. Hay fever (also known as allergic rhinitis) is caused when an allergen enters the nose or eyes. Allergens are harmless airborne substances the body has incorrectly identified as harmful. This triggers an immune response, which leads to the release of inflammatory chemicals (mediators) – one of which is histamine. Allergens that trigger hay fever differ from person to person. Common seasonal allergens include tree, grass and weed pollens (year-round allergens include dust mites, mould and pet dander). It’s now <a href="https://www.sciencedirect.com/science/article/pii/S132602002302191X">pollen season</a> in many parts of Australia, with pollen counts at their highest and hay fever cases surging. So what medicines can prevent or reduce hay fever symptoms, and how do they work? <h2>Antihistamines</h2> Knowing the release of histamine is a cause of hay fever symptoms, it’s unsurprising that anti-histamines are one of the most frequently recommended medicines to treat hay fever. Antihistamines block histamine from binding to histamine receptors in the body and having an effect, reducing symptoms. In Australia, we broadly have two types. The older sedating (introduced in the <a href="https://www.tga.gov.au/news/safety-alerts/first-generation-antihistamines-winter-warning">1940s</a>) and newer, less-sedating (introduced in the 1980s) antihistamines. Less-sedating antihistamines used to treat allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne) and fexofenadine (Telfast). Bilastine, which came onto the Australian market only last year, is only available from a pharmacy, on recommendation from a pharmacist. The others have been around longer and are available at supermarkets and in larger quantities from pharmacies. Cetirizine is the <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/35-cetirizine-hydrochloride#:%7E:text=Risks%20of%20cetirizine%20hydrochloride%20use,significant%20at%20the%20proposed%20doses.">most likely</a> (of the less-sedating antihistamines) to cause sedation. The older sedating antihistamines (such as promethazine) cross the blood-brain barrier, causing drowsiness and even brain fog the next day. They have lots of side effects and potential drug interactions, and as such have little place in the management of hay fever. The newer less-sedating antihistamines are <a href="https://australianprescriber.tg.org.au/articles/antihistamines-and-allergy.html#:%7E:text=Less%20sedating%20antihistamines%20are%20equally,an%20ongoing%20good%20safety%20profile">equally effective</a> as the older sedating ones. Antihistamines are usually taken orally (as a tablet or solution) but there are also topical preparations such as nasal sprays (azelastine) and eye drops. Antihistamine nasal sprays have <a href="https://www.sciencedirect.com/science/article/abs/pii/S108112061000743X">equal to or better efficacy</a> than oral antihistamines. The individual response to antihistamines varies widely. For this reason, you may need to trial several different types of antihistamines to see which one works best for you. Increasing the dose of an antihistamine, or combining an oral and topical antihistamine, does not provide any additional benefit. Paying extra for a brand name doesn’t offer any more or less effect than the generic (both have the same active ingredient and are <a href="https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet">bioequivalent</a>, which means they have the same outcomes for patients). <h2>Steroid nasal sprays</h2> If your symptoms don’t improve from antihistamines alone, a nasal spray containing a corticosteroid is often recommended. Corticosteroids prevent the release of several key chemicals that cause inflammation. How they work is complex: in part, corticosteroids “turn off” the production of late phase inflammatory mediators (cytokines and chemokines). This reduces the future release of more inflammatory mediators, which reduces inflammation. Corticosteroids and antihistamines have different mechanisms of action. Research shows corticosteroid nasal sprays are <a href="https://journals.sagepub.com/doi/full/10.2500/ajra.2016.30.4397">more effective</a> than antihistamines in controlling an itchy, runny, congested nose. But when instilled into the nose, corticosteroids <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.10.027">also reduce</a> the eye symptoms of hay fever. There are also nasal sprays that contain both an antihistamine and corticosteroid. While there are a range of corticosteroid nasal sprays containing different active ingredients, a large study published this year shows they are all <a href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1184552/full">about as effective as each other</a>, and work best when they have been taken for several days. <h2>Sodium cromoglycate</h2> Another medicine used to treat hay fever symptoms is sodium cromoglycate, which is available as an eye drop and over-the-counter in pharmacies. This medicine is known as a mast cell stabiliser. As the name suggests, it stabilises or prevents mast cells from breaking down. When mast cells break down, they release histamine and other chemicals that cause inflammation. This eye drop is both a preventative and treatment medicine, usually used before allergies strike. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375451/">Evidence shows</a> it is effective at reducing the symptoms of allergic conjunctivitis (eye inflammation from allergies). <h2>Decongestants</h2> Decongestants constrict blood vessels. They can be taken orally, administered as a nasal spray, or instilled into the eyes. When administered into the eyes it will reduce redness, and when administered into the nose, it will stop it from running. However, decongestants should be used for a short duration only and are not for long term use. In fact, if a nasal spray decongestant is used for more than five days, you can experience something called “rebound congestion”: a severe stuffy nose. <h2>Saline</h2> Saline (saltwater) nasal sprays or irrigation products are also available to flush out the allergens and provide hay fever relief. While there are not many studies in the area, there is evidence that saline irrigation <a href="https://www.cochrane.org/CD012597/ENT_nasal-saline-allergic-rhinitis#:%7E:text=Saline%20irrigation%20may%20reduce%20patient,any%20outcomes%20beyond%20three%20months">may reduce hay fever symptoms</a>. Saline is safe and is not associated with adverse effects. If you’re suffering from hay fever symptoms and unsure what to try, talk to your prescriber or pharmacist, who can guide you through the options and identify the best one for your symptoms, medical conditions and medicines. Allergen immunotherapy (or allergen shots) is another option hay fever sufferers <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-immunotherapy-faqs">may discuss</a> with their doctors. However it’s not a quick fix, with therapy taking three to five years.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213071/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-hay-fever-treatments-actually-work-and-whats-best-for-my-symptoms-213071">original article</a>.

Body

Woman dies after being accused by doctors of faking symptoms

A woman from New Zealand has passed away from a debilitating illness after being told by a doctor that her illness was “all in her head”. Stephanie Aston, 33, died after a long and public battle with Ehlers-Danlos Syndrome (EDS), a rare genetic disorder affecting the body’s connective tissue, on September 1st. EDS, of which there are 13 different variants, is often referred to as an "invisible illness", as sufferers can often appear healthy despite experiencing excruciating symptoms, such as severe migraines, dislocating joints, easy bruising, abdominal pain, iron deficiency, fainting and an abnormally fast heart-rate. Aston said she was dismissed by a doctor in 2016, who dismissed her symptoms and told her that she was faking her disease. Despite being diagnosed with EDS by three different specialists, one doctor in Auckland, who Aston referred to as 'Doctor A', suggested she was not seriously unwell and indicated she was causing her illnesses, <a href="https://www.nzherald.co.nz/nz/stephanie-aston-death-eds-sufferers-call-for-change-after-doctors-accused-woman-of-faking-illness/VX4Q6CAWRVH25I6OCKGQ4KTW4M/">The NZ Herald</a> reports. Ehlers-Danlos Syndromes New Zealand founder Kelly McQuinlan said Stephanie's death has shocked the community, and said more needs to be done for those suffering with the debilitating condition. “A lot of people are feeling very lost,” she said. “I think most people in these rare positions or invisible illnesses, definitely experience setbacks and disbelieving because things can’t be seen but really the clinical symptoms are there that are being ignored.” Ms McQuinlan described Ms Aston as a “beacon” for those with the illness in a tribute to her on Facebook. “Most people in our community have experienced some form of sort of doctors not believing them or questioning their diagnosis which is extremely hard,” she wrote. “When they see someone in their community pass away, the first thing they think is ‘What if my care is not looked after? What’s going to happen to me?’.” “At the end of the day, if symptoms aren’t managed correctly, anyone can get sick enough that they will pass away.” Image credits: Facebook

Caring

Got no COVID-19 symptoms? A gene mutation might be the reason

<div> <div class="copy"> A global study has unearthed a possible genetic reason why some people infected with the virus that causes COVID-19 show no symptoms. Human leukocyte antigens – or HLAs – are important genes that support immune function in the human body, particularly in identifying viral pathogens. And a particular variation in the HLA-B complex has been found to at least double the likelihood that a person infected with SARS-CoV-2 will be asymptomatic. For people who inherit a copy of the HLA-B15 variant from one parent, there was a 2.4 times greater chance of avoiding symptoms. Homozygous carriers — born with copies of the variant from each parent — were 8.5 times more likely to avoid symptoms. It’s a somewhat common variant among certain ethnicities – about 1 in 10 people with European ancestry are potential carriers – but having the gene is not a guaranteed protector against coronavirus symptoms. The findings, <a href="https://doi.org/10.1038/s41586-023-06331-x" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://doi.org/10.1038/s41586-023-06331-x">published</a> in Nature, have emerged from a joint study between researchers at the University of California San Fransisco and Australian institutions including Latrobe University, Monash University and the QIMR Berghofer Centre. The research came about almost by accident. <div class="in-content-area content-third content-right"><a href="https://cosmosmagazine.com/health/covid/link-between-blood-type-and-risk-of-covid-19-infection/"> </a></div> Co-lead authors Professor Stephanie Gras from Latrobe and Jill Hollenbach from UCSF first met at a research conference in May 2022 and pooled their resources to track the association of possible gene variations with COVID-19 symptoms. Their teams narrowed a group of 30,000 people with high-quality HLA data to a cohort of about 1,500 unvaccinated people who tested positive for the virus. They then focussed on five locations of interest in the HLA genes while monitoring the emergence of symptoms to determine which variants, if any, might have a greater linkage to being COVID asymptomatic. “The [SARS-CoV-2] virus gets inside cells and ‘presents’ some small part of the virus on the surface via the HLA molecule,” Gras explains. “Those act as a red flag for T cells. The cell sends the signal to the T cell that it has been infected with the virus, and the T cells get activated and kill that [infected] cell. “HLA-B15 can actually present a small part of the spike protein that is very similar between SARS-CoV-2 and seasonal coronaviruses… [that] circulate every year in the population and give us the common cold during winter most of the time. They share some similarities.” The understanding provides a possible application for future treatments. Now an association between the variant and asymptomatic cases has been identified, the Gras and Hollenbach teams have begun to study the interaction between HLA-B15 and the SARS-CoV-2 spike protein at the atomic level. That research is already underway, including at the Australian Synchrotron at the Australian Nuclear Science and Technology Organisation. “We’re doing atomic-level models of proteins to understand the interaction,” Gras says. “We want to compare the T cells within people who are asymptomatic with HLA-B15 and people who are not asymptomatic with HLA-B15. Actually, HLA-B15 is not a magic bullet, you can have it and still have severe COVID.” Image credits: Getty Images </div> <div id="contributors"> <a href="https://cosmosmagazine.com/health/covid/got-no-covid-19-symptoms-a-gene-mutation-might-be-the-reason/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/matthew-agius">Matthew Ward Agius</a>. </div> </div>

Body

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

<a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. But do they work? Or are they a waste of time and considerable amounts of money? <h2>What’s on the market?</h2> The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. <h2>What are phytoestrogens?</h2> Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" /></a><figcaption>Phytoestrogens can be consumed in foods like tofu or soy milk. <a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></figcaption></figure> <h2>What does the evidence say?</h2> In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries. However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. <h2>Can phytoestrogens help the psychological symptoms of menopause?</h2> Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog. <h2>The bottom line</h2> At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate Professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, Senior Research Dietitian in the Department of Gastroenterology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hot-flushes-night-sweats-brain-fog-heres-what-we-know-about-phytoestrogens-for-menopausal-symptoms-204801">original article</a>. Images: Getty

Body

Agoraphobia symptoms: Psychologists list the 5 main signs

Agoraphobia symptoms can include way more than the ‘homebody’ stereotype. Here's how to know if your avoidance means something more... Anxiety disorders Anxiety is nature’s way of preparing us to handle difficult situations. That’s why occasional anxiety is no problem – it’s healthy, even. But when run-of-the-mill nerves become irrational, chronic, or overwhelming, an anxiety disorder may be at play. Anxiety disorders are the most common type of mental health condition, according to research published in Dialogues in Clinical Neuroscience. An estimated 33.7 per cent of the population experiences an anxiety disorder at some point in their lifetime. Still, anxiety disorders can manifest in different ways, explains clinical therapist, Dr Joshua Estrin, who specialises in anxiety treatment. Some people experience generalised anxiety, or a persistent worry about everyday issues and situations. Others may develop what he calls more focused anxiety symptoms, like agoraphobia. What is agoraphobia? Most adults struggling with agoraphobia follow one of two common patterns, explains psychologist, Dr Peggy Loo. “One is often an extreme worry that they cannot leave the situation they’re in by their own free will, getting stuck,” she says. Others experience a disproportionate fear that something negative will occur while in a situation they have no control over – like having a panic attack or getting sick – and they won’t be able to get help or escape. “Sometimes agoraphobia may develop after a real-world negative experience you are worried about happening again, but sometimes the perceived threat alone is enough to create debilitating anxiety.” An individual with agoraphobia will often avoid certain places and situations or even opt never to leave the house without company, Dr Loo says. This avoidance behaviour is one reason the condition gets confused with its cousin, social anxiety, which triggers an intense fear or anxiety related to social situations, particularly over being judged, embarrassed, or criticised by others. What are the symptoms of agoraphobia? Diagnostically, a person with agoraphobia has an intense fear response when they’re in (or sometimes just when they’re anticipating) at least two of the following situations: using public transportation, being in open spaces, being in enclosed spaces, standing in lines or crowds, being outside of the home alone. “Even the thought of being in a certain situation can cause someone to literally feel crippled, trapped, immobilised,” Estrin says. Physical symptoms tend to show up following this abrupt surge of intense fear or discomfort, says psychotherapist, Laurie Singer. “They reach a peak within minutes and, typically, present four or more physical symptoms which can include: [heart] palpitations, sweating, trembling or shaking, a shortness of breath, the feeling of being smothered or choked, chest pain, nausea, or feeling dizzy and faint.” How common is agoraphobia? According to a study released by the Australian Bureau of Statistics (ABS), 4.6 per cent of Australian adults experience agoraphobia. But in reality, says Dr. Estrin, this rate could be much higher. The ABS suggests that only 35 per cent of people with an anxiety disorder seek treatment. And just like many mental health disorders, agoraphobia exists on a continuum – and there’s a huge range of severity. “One person might have more mild agoraphobia, experiencing anxiety when they are in very large, crowded places such as a concert or conference for work,” says clinical psychologist, Dr Tynessa. These people might get some symptoms of agoraphobia in these specific situations but are able to work around it in their daily lives by sticking to activities within their comfort zone. Until it causes a disruption in their life, these people may not address the underlying agoraphobia. “Another person might be toward the more severe end of the scale – they might be almost completely homebound,” Dr Franks says. “They will not leave home at all because of their anxiety about being in a situation where they cannot easily escape or get help.” She adds that some people describe their fears as constant, while others say theirs are triggered by specific events or demands. Can agoraphobia develop suddenly? Someone may be aware they’re experiencing symptoms of agoraphobia, Singer says. But like most forms of anxiety, it’s not always so black and white. “Those who are experiencing situational agoraphobia may opt not to engage in activities or events that create anxious feelings – [using] an out of sight, out of mind approach,” she says. Additionally, someone may not know why a panic attack occurs, yet do understand what situations can trigger it. While it can be tempting simply to avoid the trigger, it’s best to try and address this type of anxiety at its core, “as it can easily take on a life of its own,” Singer explains. If someone does notice they’ve started showing signs of agoraphobia, “we would want to watch and wait to see if the anxiety they’re experiencing persists, or if it turns out to be an isolated experience,” Dr Franks says. In some cases, the anxiety may have been present all along, but the person hadn’t noticed it affecting their life or hadn’t really put the pieces together to realise that their agoraphobia has been more longstanding, she says. If you do start to notice that you’re avoiding certain situations, places, or things you previously enjoyed, Singer suggests speaking with a professional at the earliest signs. Written by Leslie Finlay. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/conditions/mental-health/agoraphobia-symptoms-psychologists-list-the-5-main-signs" target="_blank" rel="noopener">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank" rel="noopener">here’s our best subscription offer.</a> Image: Getty Images

Mind

Long COVID symptoms not ‘all in the head’

Researchers have found new evidence linking COVID-19 and changes to the brain. A <a href="https://kirby.unsw.edu.au/news/least-two-thirds-australians-including-children-and-adolescents-have-had-covid-19-two-national" target="_blank" rel="noreferrer noopener">recent survey</a> has shown that at least two thirds of all Australians have had COVID-19 and in the US figures suggest that around <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm" target="_blank" rel="noreferrer noopener">one in five adults</a> will develop long-term effects from infection. ‘<a href="https://cosmosmagazine.com/health/is-long-covid-real-numbers/" target="_blank" rel="noreferrer noopener">Long COVID</a>’ effects can include lasting neurological issues, as well as changes to vital organs such as the heart and lungs, even when the original COVID-19 infection was asymptomatic. Sufferers of long COVID often report trouble sleeping, difficulties concentrating or thinking, changes in mood (such as heightened levels of depression or anxiety) and complications like headaches, light-headedness, pins and needles and changes in the sense of smell or taste. Now, <a href="https://press.rsna.org/timssnet/media/rsna/newsroom2022.cfm" target="_blank" rel="noreferrer noopener">researchers have found evidence</a> for significant changes in parts of the brain that may correspond to many of the most common neurological symptoms. Using a specialised type of MRI scan known as ‘magnetic susceptibility’ researchers compared the brains of 46 patients up to six months after they have recovered from COVID-19 with a control group of 30 healthy participants. Magnetic susceptibility is often used to detect and keep an eye on other conditions like microbleeds, tumours and strokes. “Our study highlights this new aspect of the neurological effects of COVID-19 and reports significant abnormalities in COVID survivors,” said study co-author Sapna S. Mishra, a Ph.D. candidate at the Indian Institute of Technology in Delhi. <div class="newsletter-box"> </div> Although there have been reports on abnormalities in magnetic susceptibility of the brain post-COVID-19 recovery, there has so far been little research on it. These ‘abnormalities’ include significant changes in the parts of the frontal lobe and brain stem. Affected parts of the <a href="https://cosmosmagazine.com/news/does-language-born-into-change-our-brains/" target="_blank" rel="noreferrer noopener">frontal lobe</a> are associated with understanding and forming language, cognitive functions such as attention, motor inhibition and imagery, as well as social cognitive processes, while changes in the brain stem were in regions associated with systems controlling hormone regulation, sensory relay and maintaining circadian rhythms. “These brain regions are linked with fatigue, insomnia, anxiety, depression, headaches and cognitive problems,” Mishra said. “This study points to serious long-term complications that may be caused by the coronavirus, even months after recovery from the infection.” At this stage, the study only provides a snapshot of patients up to 6 months post-recovery, although the research team plan to continue monitoring the patient cohort. “The present findings are from the small temporal window,” said Mishra. “However, the longitudinal time points across a couple of years will elucidate if there exists any permanent change.” <div class="advert ad-in-content"> <div id="adn-00000000001fc2ca" style="display: none;"></div> </div>  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=225622&title=Long+COVID+symptoms+not+%E2%80%98all+in+the+head%E2%80%99" width="1" height="1" />  <div id="contributors"> <a href="https://cosmosmagazine.com/science/biology/long-covid-not-all-in-the-head/" target="_blank" rel="noopener">This article</a> was originally published on Cosmos Magazine and was written by Clare Kenyon. Image: Getty Images </div>

Mind

Long COVID: How lost connections between nerve cells in the brain may explain cognitive symptoms

For a portion of people who get COVID, symptoms continue for <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6october2022" target="_blank" rel="noopener">months or even years</a> after the initial infection. This is commonly referred to as “long COVID”. Some people with long COVID complain of “<a href="https://theconversation.com/what-is-and-what-isnt-brain-fog-190537" target="_blank" rel="noopener">brain fog</a>”, which includes a wide variety of cognitive symptoms affecting memory, concentration, sleep and speech. There’s also growing concern about findings that people who have had COVID are at <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext" target="_blank" rel="noopener">increased risk</a> of developing brain disorders, such as dementia. Scientists are working to understand how exactly a COVID infection affects the human brain. But this is difficult to study, because we can’t experiment on living people’s brains. One way around this is to create <a href="https://www.nature.com/articles/s41578-021-00279-y" target="_blank" rel="noopener">organoids</a>, which are miniature organs grown from stem cells. In a <a href="https://www.nature.com/articles/s41380-022-01786-2.pdf" target="_blank" rel="noopener">recent study</a>, we created brain organoids a little bigger than a pinhead and infected them with SARS-CoV-2, the virus that causes COVID-19. In these organoids, we found that an excessive number of synapses (the connections between brain cells) were eliminated – more than you would expect to see in a normal brain. Synapses are important because they allow neurons to communicate with each other. Still, the elimination of a certain amount of inactive synapses is part of normal brain function. The brain essentially gets rid of old connections when they’re no longer needed, and makes way for new connections, allowing for more efficient functioning. One of the crucial functions of the brain’s immune cells, or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768411/" target="_blank" rel="noopener">microglia</a>, is to prune these inactive synapses. The exaggerated elimination of synapses we saw in the COVID-infected models could explain why some people have cognitive symptoms as part of long COVID. Parallels with neurodegenerative disorders Interestingly, this pruning process is believed to go awry in several disorders affecting the brain. In particular, excessive elimination of synapses has recently been linked to <a href="https://www.nature.com/articles/s41593-018-0334-7" target="_blank" rel="noopener">neurodevelopmental disorders</a> such as <a href="https://www.nature.com/articles/s41593-018-0334-7" target="_blank" rel="noopener">schizophrenia</a>, as well as <a href="https://www.frontiersin.org/articles/10.3389/fncel.2019.00063/full" target="_blank" rel="noopener">neurodegenerative disorders</a> such as Alzheimer’s and Parkinson’s disease. By sequencing the RNA of single cells, we could study how different cell types in the organoid responded to the virus. We found that the pattern of genes turned on and off by the microglia in our COVID-infected organoids mimicked changes seen in neurodegenerative disorders. This may go some way in explaining the link between COVID and the risk of developing certain neurological disorders. <figure class="align-center "><img src="https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491380/original/file-20221024-17-9wi5pg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" alt="" /><figcaption>A brain organoid used in our study. You can see the microglial cells in red. Sellgren lab, Author provided</figcaption></figure> A possible target for treatment One limitation of our research is that our organoid models closely resemble the foetal or early brain, rather than the adult brain. So we can’t say for sure whether the changes we noted in our study will necessarily be reflected in the adult brain. However, some <a href="https://pubmed.ncbi.nlm.nih.gov/33248159/" target="_blank" rel="noopener">post-mortem</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35255491/" target="_blank" rel="noopener">imaging studies</a> report neuronal death and reduction in grey matter thickness in COVID patients, which hints at similar instances of synapse loss caused by an infection in adults. If this proves to be a fruitful line of enquiry, we believe our findings could point to a mechanism contributing to persisting cognitive symptoms after COVID and other viral infections that affect the brain. SARS-CoV-2 is an RNA virus and similar <a href="https://pubmed.ncbi.nlm.nih.gov/27337340/" target="_blank" rel="noopener">processes</a> have been seen in mice infected with other RNA viruses that can also cause residual cognitive symptoms, such as the <a href="https://pubmed.ncbi.nlm.nih.gov/31235930/" target="_blank" rel="noopener">West Nile virus</a>. From here we want to study how different drugs could inhibit the changes we saw in the infected models, hopefully paving the way towards effective treatments. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410571/">other research</a>, we’ve observed that an antibiotic called minocycline can reduce the degree to which microglia prune synapses in a dish. So we want to see if this drug can help in our brain organoid models following SARS-CoV-2 infection.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/192702/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Writen by Samudyata and Carl Sellgren. Republished with permission from <a href="https://theconversation.com/long-covid-how-lost-connections-between-nerve-cells-in-the-brain-may-explain-cognitive-symptoms-192702" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

Mind

The surprising reason exercise improves symptoms of Alzheimer’s

Though we already know that physical activity is good for us, new research has discovered that it may have even more benefits for those with Alzheimer’s disease. A team of researchers have <a rel="noopener" href="https://www.scimex.org/newsfeed/why-exercise-is-beneficial-for-those-with-alzheimers" target="_blank">identified</a> a potential explanation for why exercise improves brain health. Dr Kaitlin Casaletto, the study’s senior author and a neurophysiologist at the University of California’s Memory and Ageing Centre, said the study makes the link between exercise and better brain health via inflammation. “We are starting to show the ‘who of the how’: physical activity related to better cognitive outcomes via reduced brain inflammation, particularly in adults with greater Alzheimer’s disease pathology,” she told OverSixty. “Broadly, our study supports the dynamic and plastic nature of the brain, even in older adults and even in the context of pathology.” The researchers monitored the activity of microglia - the brain’s immune cells - in 167 older adults, as well as the levels of activation in brain tissue from deceased patients with Alzheimer’s. As the brain’s first line of immune defence, the cells activate to remove debris, damaged neurons, and foreign invaders. But, if the cells are too active, they can trigger inflammation, damage neurons, and interrupt signalling in the brain. This was particularly noticeable in a region of the brain responsible for processing visual information. This area is one of the regions severely impacted by Alzheimer’s disease, resulting in difficulty processing new information and remembering it later. <blockquote class="twitter-tweet"> <a href="https://twitter.com/hashtag/JNeurosci?src=hash&ref_src=twsrc%5Etfw">#JNeurosci</a> | New research from <a href="https://twitter.com/UCSFmac?ref_src=twsrc%5Etfw">@UCSFmac</a> shows physical activity may improve <a href="https://twitter.com/hashtag/Alzheimers?src=hash&ref_src=twsrc%5Etfw">#Alzheimers</a> by lowering brain inflammation. <a href="https://twitter.com/kbcasaletto?ref_src=twsrc%5Etfw">@kbcasaletto</a> et al. show benefits may come through decreased immune cell activation. <a href="https://t.co/ZSgCVfnPCQ">https://t.co/ZSgCVfnPCQ</a> <a href="https://t.co/oSganHTYHj">pic.twitter.com/oSganHTYHj</a> — SfN Journals (@SfNJournals) <a href="https://twitter.com/SfNJournals/status/1462844838576017418?ref_src=twsrc%5Etfw">November 22, 2021</a></blockquote> Physical activity was also found to have a pronounced effect in reducing inflammation in people with severe Alzheimer’s. “For instance, our study suggests that individuals at risk for Alzheimer’s related inflammation may particularly benefit from an exercise regimen,” Dr Casaletto said. But, she said it’s important to understand that exercise “may not work for everyone’s brain health”. Previous work has made the connection between exercise and reduced risks of neurodegenerative diseases such as Alzheimer’s, but Dr Casaletto said the new study is the first to show the same kinds of results in humans. “Many studies show that physical activity relates to better brain and cognitive health. Yet we still do not fundamentally understand the mechanisms linking physical activity to cognition in humans,” said Dr Casaletto. “Ours is the first human data showing that brain inflammation may be a meaningful mechanism.” The researchers also noted that exercise could be used to identify potential treatments. “Our team aims to identify biological targets that link known neuroprotective factors like physical activity to the brain,” Dr Casaletto said. “Ideally, if we can ‘bottle’ these biological mechanisms, they could be therapeutic targets for cognitive ageing and Alzheimer’s disease.” The study was published in the <a rel="noopener" href="https://www.jneurosci.org/content/early/2021/11/11/JNEUROSCI.1483-21.2021" target="_blank">Journal of Neuroscience</a>. Image: Getty Images

Mind

5 surprising silent symptoms of clogged arteries

How common are clogged arteries? Each year in Australia, according to the Heart Research institute, about 75,000 people have a heart attack and 17,500 people die of coronary heart disease (CHD). Preventing heart disease in patients is a physician’s main goal, but early detection is the next best thing. This can lead to changes in lifestyle and medical therapies that can delay or deny the onset of a heart attack; almost 80 per cent of heart disease is preventable with lifestyle changes. Many of my patients are shocked to learn about the following unexpected symptoms of clogged arteries and heart disease. Erectile dysfunction (ED) Men have a built-in warning system for silent CHD. When achieving an erection is difficult or impossible, it can be one of the symptoms of clogged arteries in the pelvis that presents before a heart attack hits. There are, on average, three to five years between the onset of erectile dysfunction (ED) and the finding of CHD, which is plenty of time to detect and work on preventing heart issues. If you and your partner are worried about sexual performance, it’s smart to look for and treat the root causes of diseased arteries before automatically turning to a blue pill for ED. Calf pain when you walk This is known as claudication (from the Latin for ‘to limp’). Atherosclerosis can block leg arteries, particularly in smokers, before CHD is diagnosed. This symptom requires an evaluation without delay. Your doctor will examine the pulses in your legs and perform simple measurements of leg blood pressure and blood flow to confirm a diagnosis of poor circulation. It is crucial that heart disease be diagnosed as early as possible because there are many dietary and medical treatments that can help reverse the problem. I advise my patients to eat more plant-based foods and fewer animal products and to start a walking program. Their calf pain completely resolved within weeks and has not recurred for years. Anyone with any of the above signs of silent CHD should know his or her numbers (blood pressure, cholesterol and fasting glucose). Ask your doctor if you should be checked for heart disease with electrocardiography, or EKG, a coronary calcium CT imaging, or exercise stress testing. Tight jaw A tight jaw, one of the symptoms of clogged arteries, occurs more often in women, but men should be aware of it, too. Aches and pains in the jaw and neck are common symptom of angina, which is the discomfort that results from poor blood flow to part of the heart. The pain occurs because the vagus nerve (the main nerve that carries pain signals from the heart) is in constant contact with the neck, jaw, head, and left arm. Visit your doctor to find out if your jaw pain is the result of something benign, such as teeth grinding, or if it’s something you’ll want to monitor with caution. Lower back pain Your lower back pain might not be a simple sign of ageing muscles. According to the Physicians Community for Responsible Medicine, the lower back is also often one of the first parts of the body to accumulate plaque. You’ll feel pain because the reduced blood flow to the area can weaken the discs that cushion the vertebrae. Smoking habit The chemicals in tobacco damage the structure and function of your blood vessels and damage the function of your heart. This damage increases your risk of atherosclerosis, according to the Heart Foundation. One of the best things you can do to decrease your risk of CHD is to quit. Written by Dr Joel K. Kahn. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/5-surprising-silent-symptoms-of-clogged-arteries" target="_blank" rel="noopener">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank" rel="noopener">here’s our best subscription offer.</a> Image: Getty Images

Body

Lockdowns doubled your risk of mental health symptoms

During the almost two years of on-again off-again COVID lockdowns, we heard lots of concern from many different corners about the mental health effects of forcing people to stay home and keep away from friends and family. Many research projects were undertaken to attempt to measure the scale of the impacts on mental health. However, the speed with which research was generated meant in some cases, research quality was sacrificed, and some research found evidence of an effect on mental health, and some didn’t. To make sense of the very mixed findings, my colleagues and I conducted a <a href="https://www.sciencedirect.com/science/article/pii/S2352250X22000252">review</a> of all of the studies on mental health conducted during the first year of the pandemic. We included 33 published papers which studied a total of nearly 132,000 people across various world regions. We found that overall, social restrictions doubled people’s odds of experiencing mental health symptoms. This means, of those who participated in these studies, those who experienced lockdowns were twice as likely to experience mental ill health than those who didn’t. This finding can be broken down further by different mental health symptoms. Social restrictions saw the odds people would experience symptoms of depression increase by over 4.5 times, the odds of experiencing stress increased by nearly 1.5 times, and the odds of experiencing loneliness almost doubled. When we drilled down further into these results, we found the length and strictness of lockdowns affected mental health symptoms differently. For example, strict lockdowns increased depression, whereas the onset of social restrictions increased stress. Low social restrictions, where there were some restrictions in place but not total lockdown, were associated with increases in anxiety. Also, mental health outcomes differed by age, with young and middle-aged adults reporting greater negative mental health symptoms than older adults. <h2>What lessons can we take away from these findings?</h2> The findings give us a good idea of what public health outreach should look like in the event of future pandemics. Anxiety was most prevalent when low restrictions were introduced. This could be due to the fact people were nervous about the precarity of the situation and where the virus could be circulating. The introduction of such measures should be accompanied by public health messaging and interventions that focus on alleviating chronic fear and worry. During the periods of strict social restrictions, the predominant mental health issue was depression, meaning mental health responses should focus on combating depressive-related symptoms such as hopelessness and loss of purpose. The findings for stress suggest symptoms are likely to intensify during the early stages of social restriction enforcement. This is probably because the onset of restrictions communicates to people an increase in the seriousness of the pandemic threat, and people have to work very hard to re-organise their lives if restrictions involve the need to work from home and home-school. During these times, providing messaging and interventions that help people manage their stress, such as dealing with work stress or the stress of home-schooling children, may be especially important. For parents, making them feel capable in the home classroom and promoting strategies that foster positive family functioning (such as more constructive communication and problem-solving) could reduce parental and family stress. Given social restrictions were found to be associated with increases in loneliness, promotion of digital technologies to keep people feeling connected is also important. Across all these mental health issues, messages that communicate these symptoms are to be expected are likely to help individuals normalise and acknowledge the nature and severity of their symptoms. This, in turn, may prompt people to seek help for their mental health symptoms. <h2>Research quality was poor</h2> Another important point to highlight from our review is the research conducted during the first year of the pandemic was generally of poor quality. This is because good measures of social restrictions were hard to come by in studies. Some studies didn’t detail the specific restrictions in place in various cities, or did not ask study participants to what extent they complied with restrictions. Also, some studies surveyed people’s mental health symptoms on the day social restrictions were first enforced. Most people are likely to experience heightened but temporary spikes in mental health symptoms that may naturally reduce after the initial lockdown announcements. This means it’s difficult to get a handle on the “true” mental health effects of social restrictions on the first day restrictions are activated. However, the effects of social restrictions on mental health symptoms were similar across studies where people were surveyed at one time point and where they were surveyed on more than one occasion during restrictions. This suggests the estimated effects seem robust, despite many studies not having the best assessments of social restrictions. The findings of our review show that although we have a way to go in the way we conduct research into the mental health effects of COVID-19 social restrictions, the initial research highlights these restrictions indeed negatively impacted the mental well-being of citizens. Although such restrictions may be an effective public health response to mitigate the spread of viruses such as COVID-19, there needs to be a co-ordinated response to safeguard people’s physical and mental health. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/lockdowns-doubled-your-risk-of-mental-health-symptoms-180953" target="_blank" rel="noopener">The Conversation</a>.

Mind

8 sneaky female heart attack symptoms women might be ignoring

Women aren't menThere’s a big disconnect between what women think a heart attack would feel like – excruciating chest pain – and what it often does feel like. “Other than the reproductive system, the cardiovascular system has the most differences between genders,” says Professor Jean McSweeney, PhD, RN. So it’s to be expected that female heart attack symptoms – while sometimes shared with men in a general sense – can also be experienced differently. After all, “we have much smaller vessels in our heart,” says Dr McSweeney, who was among the first to zero in on women’s heart attack symptoms in a 2003 study, published in the journal Circulation. “And we’re constructed differently.”When a woman’s main arteries are blocked, she’ll often experience a constellation of signs, including chest pain, pressure or tightness, along with multiple non-chest symptoms, says Judith Hilevi Lichtman, PhD, department chair and associate professor of epidemiology at the Yale School of Public Health. What’s more, not every woman experiences the same symptoms, and the symptoms don’t necessarily happen all at once. We spoke with experts and female heart-attack survivors about what some of those symptoms might be and what they feel like. Here are eight that surprised us most.A strange-feeling arm“I felt like my arm was asleep,” says Tara Robinson, a school counsellor, who, incredibly, survived three heart attacks in one week at the age of 40. For the first two, the feeling would emerge for a couple of minutes and then go away. By the time she arrived at the hospital, the symptoms were gone and she was sent back home without treatment. “I thought maybe I was working out too hard at the gym or I slept on my arm wrong,” she says. By the time the third heart attack struck, that feeling was much more intense and persistent – and impossible to ignore.Another heart attack survivor, Lilly Rocha, described her arm as feeling “sore.” In fact, she felt general soreness in her entire upper left side, along with her jaw and chest. At the time, she was 37 and a corporate vice president who organised international events; she’d jet-set from country to country on a regular basis – so she attributed the soreness to the stress of travel. It wasn’t until a co-worker (who had himself experienced a heart attack) insisted on taking her to a hospital did she realise the shocking truth: She’d just had a heart attack.A really sore jawAlong with arm issues, fatigue and shortness of breath, jaw problems often emerge months before an attack and then intensify during the actual event. Robinson described it as “like the way your mouth feels after you’ve come home from the dentist and the Novocaine hasn’t quite worn off.” As with the arm, the jaw also acts up because of what doctors call “referred” pain, explains Suzanne Steinbaum, DO, attending cardiologist and the director of Women’s Cardiovascular Prevention, Health, and Wellness at The Mount Sinai Hospital in New York City and author of Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life. “That pain comes from the heart,” she says. Dr McSweeney recalls a patient who first complained about her jaw to her dentist and was given treatment for TMJ. When that didn’t help, her wisdom tooth was removed. Of course, the pain only got worse – until she ended up in the hospital with a heart attack and was finally properly treated.Nausea and vomitingIn a 2018 Circulation study that examined women and men who experienced a heart attack before age 55, two-thirds of women said they’d experienced epigastric (upper-abdominal) issues, such as indigestion, nausea, or stomach pain, notes Dr Lichtman, the article’s lead author. Only half the men reported similar problems. As Robinson describes that day she was rushed to the hospital with her third heart attack: “I wanted to vomit so badly.” After treatment, she adopted lifestyle changes that included eating a heart-healthy diet. She now helps lead other patients in living healthier.Shortness of breathThis can catch you by surprise while you’re in the middle of running a meeting at work, doing household chores, or even lying down. An early symptom of a heart condition can be the need to prop yourself up in bed in order to breathe better. “You feel out of breath because when your arteries are blocked, there is not enough oxygen being delivered throughout the body,” explains Dr Steinbaum. “If the heart has been damaged or a heart attack is happening, the heart may not have the ability to push the blood forward and this can cause fluid to back up into the lungs.”Extreme fatigue“Women tend to dismiss heart attack symptoms because we are used to feeling uncomfortable on a monthly basis,” says Dr Steinbaum. “The key to knowing when to get checked is to assess whether the things you do every day and are normal for you suddenly become difficult or you get symptoms while trying to do them.” Robinson remembers having to crawl back to her bedroom after cleaning her shower; she felt weak and wanted to take a nap.Dr McSweeney tells of one patient who reported being so tired that she could only make one side of the bed. She needed to rest before making the other. “It’s not this pronounced in every woman,” says Dr McSweeney. But if the fatigue gets progressively worse, or you don’t feel better after you’ve slept, you should see your doctor.When Rocha was hit with episodes of extreme fatigue, she blamed it on her hectic travel schedule. By the time she arrived at the hospital, where she waited a long time to be seen – no one suspected she was having a heart attack – the fatigue and feelings on the left side of her body became so overwhelming that she couldn’t move or talk. “I felt like I was going to pass out,” she says. Fortunately, she received treatment before it was too late. She now owns her own company in order to have control over her work-life balance.Upper-back painRobinson reports that her back problem was the only symptom she’d describe as actually painful. “It felt as if it was behind my heart,” she says. Other women have described it as a sharp pain between the shoulder blades, which intensified at the time of the heart attack.An odd feeling in the chestWomen don’t necessarily describe it as “chest pain” – much less a “Call an ambulance!” kind of pain. “They may call it ‘chest tightness’ or ‘chest pressure,’” says Dr Lichtman, who adds that women may not associate their symptoms with a heart attack because they’re experiencing other symptoms unrelated to the chest, like fatigue or muscle pain. Rocha felt a “strong tingling sensation – almost like electricity was shooting out of my chest.” It would come and go, she recalls, and in the beginning would last two or three minutes at a time. About six months before her heart attack, she went to her primary care physician (who was also her ob-gyn) because she was convinced she had breast cancer. The doctor did a breast exam, found nothing, and sent her home. Rocha eventually noticed that her entire left side – chest, jaw, and arm – just felt “weird.”Flu-like symptoms“Women might say, ‘I’m so tired. I must have a virus,’” says Dr Steinbaum. They might convince themselves that all they have are flu symptoms, many of which resemble the conditions above, including body aches, fatigue and nausea. But if the sensations seem different or more intense than anything you’ve felt before, get it checked out. While they may turn out not to be symptoms of a heart condition or precursors to a heart attack, you’re better off not ruling out the possibility – even if you’re under 55 and especially if you have a family history of early-onset heart disease. If you have even the slightest thought that you might be having a heart attack, call an ambulance.Wear Red Day is Feb 14, Valentine’s Day, but <a href="https://www.heartresearch.com.au/redfeb/" target="_blank" rel="noopener">Heart Research Australia</a> is raising awareness for the whole month of February (aka RedFeb). Getting involved is as simple as wearing red and donating. #wearredanddonateWritten by Joanne Chen. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/conditions/heart-blood-pressure/8-sneaky-female-heart-attack-symptoms-women-might-be-ignoring" target="_blank" rel="noopener">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank" rel="noopener">here’s our best subscription offer.</a>Image: Getty Images

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8 bipolar symptoms you might be ignoring

What is bipolar disorder? There are two commonly diagnosed types of bipolar disorder, a mental illness characterised by mood swings from emotional highs to lows. People with bipolar I have depression alternating with severely elevated mood, or mania. Bipolar II is much more common, and is marked by less severe manic symptoms, called hypomania. Since the characteristics of bipolar disorder exist along a spectrum ranging from non-existent to extreme, and because good or bad moods can be a result of temporary events or circumstances rather than a mental illness, diagnosis of bipolar disorder can be difficult. These signs will reveal if you’re going through a phase or revealing bipolar symptoms. You're downright depressed A bipolar person in a depressive state will have the same symptoms as someone who has only depression. “They have the same problems with energy, appetite, sleep, and focus as others who have ‘plain old depression,’” psychiatrist, Dr Don Malone, tells Health. The period of mania, or elevated mood, that follows the depression is what differentiates a bipolar diagnosis. It’s important to discuss fluctuations in mood with your therapist because the treatment for depression will be different from bipolar disorder treatment. “Antidepressants can be downright dangerous in people with bipolar because they can send them into mania,” says Dr Malone. Signs of depression include: feeling sad or hopeless for long periods of time, withdrawal from family or friends, lack of interest in activities you used to enjoy, significant changes in appetite, lack of energy, slow speech, problems concentrating, and preoccupation with death. You can't sleep It’s common to have periods of insomnia due to stress or anticipation of something exciting on the horizon. But someone in a manic phase of bipolar disorder will require significantly less sleep than usual (sometimes none at all) for days at a time – and still feel energised. During a depressive phase, a person may sleep for longer than usual. Professor of psychiatry, Dr Carrie Bearden, tells Health that staying on a regular sleep schedule is one of the first things she recommends for bipolar patients. You're in a great mood - a really, really great mood! Who wouldn’t love to be in a great mood? And why would anyone see that as a sign of mental illness? “These phases of the disorder may actually be enjoyable to the individual because they allow for increased productivity and creativity that they normally might not experience,” says psychiatrist, Dr Smitha Murthy. But if the mood elevation is extreme, there is no apparent cause for it, it lasts for a week or longer, or it appears in combination with other symptoms, it may be one of your bipolar symptoms. Hypomania, characteristic of bipolar II, may be even harder to differentiate from a generally good mood because the symptoms are milder. Look for a combination of elevated mood with other bipolar symptoms, especially in a repetitive cycle that alternates with depression. You get distracted easily Trouble concentrating, a tendency to jump from task to task, or being generally unable to finish projects may be attributed to flightiness, stress, or other factors. But if you’re so distracted that you’re unable to get anything done, and it’s interfering with your work or relationships, you might be showing bipolar symptoms, says Dr Murthy. You're unusually irritable “This is one of the trickiest symptoms to recognise since it’s a natural reaction to frustration or unfairness,” says Dr James Phelps. Getting upset that someone cut you off on the highway, for example, is pretty normal. “Anger out of proportion to the situation, rising too fast, getting out of control, lasting for hours, and shifting from one person to another, would differentiate the behaviour as a possible bipolar symptom,” he says. You talk - and think - fast A “chatty Cathy” is not abnormal, says Dr Phelps. “But talking so fast that others can’t keep up or understand – especially in phases with other bipolar symptoms, may be hypomania,” he adds. Someone in a manic state may not even let another person get a word in. This type of rapid speech is especially concerning if a person doesn’t speak this way typically. Similarly, racing thoughts or ideas that come so quickly that others – and even you yourself – may not be able to keep up may be indicative of mania. You're extremely confident - but don't make good decisions Normally, high self-esteem is a good thing. In a person with bipolar disorder, excessive confidence could lead to poor decisions. “They feel grandiose and don’t consider consequences; everything sounds good to them,” Dr Malone told Health. This may lead to taking risks and engaging in erratic behaviour you ordinarily wouldn’t attempt, like having an affair or spending thousands of dollars you can’t afford to spend. Drug and alcohol use “People with bipolar disorder have a higher than average rate of a co-occurring substance or alcohol use,” says Dr Murthy. They may try to calm themselves with alcohol or drugs during a manic phase, or use them to cheer up during a depression. Written by Ilisa Cohen. This article first appeared in <a rel="noopener" href="https://www.readersdigest.com.au/healthsmart/8-bipolar-symptoms-you-might-be-ignoring" target="_blank">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a rel="noopener" href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank">here’s our best subscription offer.</a> Image: Getty Images <img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" />

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