10 Facts About Endometriosis

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Eye-popping pain. Bloating. Heavy periods. Infertility. These are all symptoms of endometriosis, a chronic ailment that is believed to affect up to one in 10 women between the ages of 15 and 49. It can also take a serious toll on patients' mental health. Here's what you need to know about this condition.

1. THE NAME DOESN'T REVEAL MUCH ABOUT THE CONDITION.

Endometriosis, or endo, for short, gets its name from endometrium—the thin layer of tissue that lines a woman's uterus. "Endo is a condition in which endometrial-like tissue grows outside of the uterus, typically in the pelvic area," says Kristin Patzkowsky, M.D., an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine. Common sites for endometrial growths, called lesions, include the ovaries, fallopian tubes, outer surface of the uterus, and the ligaments and other tissues that hold the uterus in place. The number of lesions can vary and range in size from a few millimeters to grapefruit-size.

2. DOCTORS AREN'T SURE WHAT CAUSES ENDOMETRIOSIS.

The most widely accepted view is that endometrial tissue relocates to other parts of the body during a woman's period. Here's a quick review of the female reproductive cycle: Each month, under the influence of the hormone estrogen, the endometrium thickens and swells in preparation for a potential pregnancy. If pregnancy doesn't occur, the endometrium sheds and flows out of the body. This bloody discharge is menstruation, commonly known as a period. But sometimes menstrual blood flows backward, passes through the fallopian tubes, and enters the pelvic cavity—what doctors call retrograde menstruation. This backward flow can carry endometrial tissue to places far afield of the uterus, such as the digestive tract, lungs, and even the brain. It's been proposed that these transplants set up shop in their new locations, where they continue to respond to the cyclical influences of estrogen by swelling and bleeding each month, and causing the pain associated with endo.

There's an issue, though: Almost all women experience retrograde menstruation, so according to Patzkowsky, doctors don't know why some get endo and others don't. Some researchers think an imbalance in reproductive hormones might be to blame, while others suggest that a faulty immune system—which would normally curb the growth of endometrial cells outside their normal locale—may be responsible. Risk factors for endo include long periods (more than seven days), short cycles (less than 27 days), and having a family member who has endo.

3. PAIN IS A CLASSIC SYMPTOM …

Some women with endo feel pain in the back or chest, and others experience discomfort during or after sex or have painful, heavy periods. Since the pelvic region serves as a crossroads for a variety of organ systems, discomfort when urinating or having bowel movements is common. Some endo sufferers have a concurrent—but not the same—condition called adenomyosis, in which endometrial tissues grow into the muscular wall of the uterus. Endo can also cause large painful cysts on a woman's ovaries, called endometriomas. Often called "chocolate cysts," due to their dark, chocolatey appearance, endometriomas are noncancerous, fluid-filled growths that typically form deep within the ovaries. Mysteriously, some women experience no pain at all, Patzkowsky says. One study found that nearly 90 percent of women with endo experience depression and anxiety. According to some mice studies, it's possible that endo reprograms the brain, making women more vulnerable to mental health problems—although other researchers think the depression and anxiety are more to do with the pain and fertility problems.

4. … AND SOME WOMEN CAN EVEN EXPERIENCE INFERTILITY.

As many as half of all infertile women have endo, and up to 50 percent of women with endo are infertile—but doctors aren't sure how the condition affects a woman's ability to get pregnant. Endo lesions can block or scar a woman's reproductive organs, making it harder for the egg and sperm to meet up, but it's also possible that the scarring prevents the endometrium from developing properly each month, preventing implantation. Other theories suggest that the inflammatory milieu that accompanies endo creates an unfavorable environment for pregnancy.

5. MANY WOMEN WITH ENDO GO UNDIAGNOSED.

Up to one in 10 of all pubescent girls and women worldwide have endo. In the U.S., that translates to some 6.5 million females of reproductive age. Some experts say the number is higher because many women go undiagnosed. That's because some women confuse the pain of endometriosis with normal period pain, and others just don't talk about it. On the other hand, "Not all menstrual pain is endo," Patzkowsky says.

6. THERE ARE SEVERAL WAYS TO LOOK FOR ENDO, BUT ONLY ONE WAY TO BE SURE.

The first step is usually a pelvic exam. The doctor will feel for cysts or areas of scar tissue behind a woman's uterus, in an area called the Pouch of Douglas, a common site of endometrial lesions. If the doctor suspects endo, an ultrasound or MRI will often provide more information. The only sure way to diagnose endo, however, is laparoscopy with biopsy—a minimally invasive surgical procedure that allows a doctor to view a woman's internal organs using a small camera and take tissue samples (biopsies) for testing. Laparoscopy is considered the gold standard of endo diagnosis.

Diagnosis also involves determining the stage of the disease based upon the location, size, and depth of the lesions; the presence and size of endometriomas in the ovaries; and the presence of scar tissue. Most women have mild scarring and only superficial lesions, indicating that they have minimal or mild endo. Women with endometriomas and more severe scarring have moderate or severe endometriosis.

In an odd twist, "The stages don’t necessarily correlate with the types of symptoms or degree of pain a woman experiences," Patzkowsky says. For some women, a further element of diagnosis is determining her likelihood of getting pregnant, using the Endometriosis Fertility Index [PDF], a scoring system that considers a woman's age, reproductive and infertility history, and endo severity to predict her chances of conceiving.

7. TREATMENTS AIM TO REDUCE THE SIZE OF THE LESIONS.

If a woman with endo doesn't want to get pregnant, her doctor might prescribe hormonal treatments to reduce the amount of estrogen in her body. Extended cycle and continuous cycle birth control methods reduce or eliminate the number of periods a woman has, blocking the cyclical effects of estrogen. If pregnancy is the goal, however, a woman's doctor might briefly prescribe gonadotropin-releasing hormone agonists—hormone-blocking drugs that induce a sort of temporary menopause that stops a woman's production of estrogen and can often decrease the size of endo lesions. The treatment period typically lasts several weeks to a few months. When the treatment ends, the woman's body will begin to produce estrogen again, providing her a brief window of time in which she has a chance of getting pregnant before the lesions return.

Surgery to remove endo lesions is also an option, but only in severe cases or in situations when a woman can't take hormonal therapies or hormones haven't been successful in the past.

8. ENDO IS COSTLY, AND NOT JUST IN DOLLARS.

Quality-of-life assessments don't accurately capture the toll endo takes on women: Findings from a 2011 study of more than 1400 women with endo found that women lost more than 11 hours of work each week chiefly due to reduced productivity (not absence). A second study, conducted in 2012, estimated that endo costs an affected woman more than $10,000 per year, comparable to diabetes, Crohn's disease, or rheumatoid arthritis. Endo also interferes with sexual pleasure and satisfaction.

9. AN ENDO DIAGNOSIS DOESN'T HAVE TO FEEL LIKE THE END OF THE WORLD.

Many women with endo lead full lives. Northern Irish politician Naomi Long and Australian swimmer Emily Seebohm, an Olympic gold medalist, have shared their personal trials with the condition. Women with endo get pregnant, too, and often have successful pregnancies. "Endo does not equal infertility," Patzkowsky says. Women with endo often find that support groups are helpful, and there's even an app (or two) to help. One advocacy group has organized a worldwide endo march to raise awareness of the disease and promote research.

10. NEW ENDO RESEARCH IS FOCUSED ON IDENTIFYING BIOMARKERS.

Future endo research is focused on not only furthering understanding of the causes and other aspects of the disease, but also on developing non-hormonal therapies to aid in treatment and identifying biomarkers—indicators in blood or easily accessible tissue samples—that can speed diagnosis. Some scientists liken endo to cancer because it has different subtypes that may have different causes, requiring an integrated approach to understanding the genetic, hormonal, metabolic, and molecular factors that influence endo development and progression.

How Often Should You Poop?

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When it comes to No. 2, plenty of people aren’t really sure what’s normal. Are you supposed to go every day? What if you go 10 times a day? Is that a sign that you’re dying? What about once every three days? Short of asking everyone you know for their personal poop statistics, how do you know how often you’re supposed to hit the head?

Everyone’s system is a little different, and according to experts, regularity is more important than how often you do the deed. Though some lucky people might think of having a bowel movement as an integral part of their morning routine, most people don’t poop every day, as Lifehacker informs us. In fact, if you go anywhere between three times a day and three times a week, you’re within the normal range.

It’s when things change that you need to pay attention. If you typically go twice a day and you suddenly find yourself becoming a once-every-three-days person, something is wrong. The same thing goes if you normally go once every few days but suddenly start running to the toilet every day.

There are a number of factors that can influence how often you go, including your travel schedule, your medications, your exercise routine, your coffee habit, your stress levels, your hangover, and, of course, your diet. (You should be eating at least 25 to 30 grams of fiber a day, a goal that most Americans fall significantly short of.)

If you do experience a sudden change in how often you take a seat on the porcelain throne, you should probably see a doctor. It could be something serious, like celiac disease, cancer, or inflammatory bowel disease. Or perhaps you just need to eat a lot more kale. Only a doctor can tell you.

However, if you do have trouble going, please, don’t spend your whole day sitting on the toilet. It’s terrible for your butt. You shouldn’t spend more than 10 to 15 minutes on the toilet, as one expert told Men’s Health, or you’ll probably give yourself hemorrhoids.

But if you have a steady routine of pooping three times a day, by all means, keep doing what you’re doing. Just maybe get yourself a bidet.

Have you got a Big Question you'd like us to answer? If so, let us know by emailing us at bigquestions@mentalfloss.com.

Why You Should Be Wary of Prescription Drug Ads on TV

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In 1997, the Food and Drug Administration permitted prescription drug companies to start publicizing their products directly to consumers in television advertisements. Compelled by the persuasive spots, patients petitioned their physicians for drugs to alleviate mood disorders, cardiovascular issues, and various other chronic conditions. But two studies released this year both came to a sobering conclusion about this direct-to-consumer approach: While advertising is persuasive by nature, drug spots may actually be misleading.

In a report published in the Journal of General Internal Medicine, researchers at Yale University looked at 97 drug ads that aired on television in 2015 and the first half of 2016. Most were targeted to people with arthritis, diabetes, and other ailments that require continuous care. None of them offered objective information about the potential risks of the drugs; the focus was instead on relative improvement in quality of life. In 13 percent of the ads, the drug companies suggested that various diabetes medications could be used off-label to reduce weight or lower blood pressure, a violation of FDA policy.

The spots also emphasized positive results of clinical trials. These efficacy statements dominated the narrative, with statements like “most people using [the drug] saw 75 percent clearer skin,” or “my doctor said [the drug] helps my bones get stronger.” The Yale study concluded that these and similar claims were potentially misleading and difficult to analyze objectively.

Another recent study published in the Annals of Family Medicine [PDF] examined the abundance of lifestyle depictions in the spots. Rather than dwell on risk factors, the 61 ads that researchers analyzed were predominantly made up of footage that made a direct connection between using the drug and an improved quality of life. Many of the ads were addressing conditions (like diabetes and depression) that might benefit from therapies other than medication. Roughly 59 percent of ads depicted a person losing control of their life as a result of their condition, while almost 69 percent suggested the advertised drugs enabled a more active and healthy lifestyle.

The FDA is responsible for making sure companies don't mislead consumers, but critics charge that the agency is not doing its part. It doesn't review prescription drug ads in advance, nor does it restrict ad spending. “Everyone on the ads appears healthy, happy, dancing, and they get better,” internist Andy Lazris, M.D. told Health News Review. “So people are led to believe a) the drug will be effective (which is often not the case), and b) that they should replace their old therapy with the newer one because it’s better (again, which is often not the case)."

“And if they give you any numbers at all, they’re almost always the deceptive relative numbers that look really good, not the more realistic absolute numbers," Lazris added. "So the benefits are over-exaggerated, the harms are downplayed or missed, and that’s how patients can get hurt.”

Because the spots are so short—usually 30 to 60 seconds—it’s difficult to communicate the risk-to-benefit ratio clearly. Even when ads go into a laundry list of side effects, it can become white noise compared to the happy, smiling faces appearing onscreen. (Soon, the FDA might even allow companies to shorten that list, based on its own study that found fewer mentioned side effects allow consumers to retain more information about the drug’s risks.)

The one part of the spots most critics agree is accurate? When they urge viewers to talk to their doctor. Weighing the risks and benefits of prescription medication outside of the fictional and persuasive images of drug spots is the only way to be sure a product is right for you.

[h/t Los Angeles Times]

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