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Fast Facts: What You Need to Know About Endometriosis
Medically reviewed by Robyn Faye, M.D.
March is Endometriosis Awareness Month.
Endometriosis is a painful condition that affects more than 11% of women ages 15-44. HealthyWomen reached out to Robyn Faye, M.D., an OB-GYN with the Abington Primary Women’s Healthcare Group and member of HealthyWomen’s Women’s Health Advisory Council, to get the basic facts.
What is endometriosis?
Endometriosis is a pelvic pain condition that occurs when tissue similar to the tissue that lines the uterus, known as endometrial tissue, becomes implanted outside the uterus and creates growths known as endometrial implants. The most common location of endometriosis is the ovaries, but it can also be found anywhere in the body, including on the fallopian tubes, behind the uterus, on the bowels or bladder, and in the peritoneum, uterosacral ligaments and rectouterine pouch (known as rectovaginal endometriosis). A small percentage of endometriosis cases affect the appendix.
What are the symptoms?
Symptoms may include chronic pain; reduced fertility; abnormal periods; painful menstrual cramps, known as dysmenorrhea, and painful sex.
You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
How is endometriosis diagnosed?
Endometriosis shares symptoms with many other conditions, so it can take a while to get a diagnosis. In fact, it generally takes 7-12 years from the onset of symptoms to a diagnosis. In most cases, symptoms eventually lead to a diagnosis, but around 20%-25% of women may be asymptomatic and are only diagnosed during a pelvic exam or ultrasound. Sometimes a diagnosis is made upon sight during a cesarean section, and a definitive diagnosis can be made with a laparoscopy, a procedure where a surgeon uses a small scope to look for endometrial tissue outside the uterus or on the uterus and other pelvic organs.
What are the risk factors for endometriosis?
If you started your period before age 11, have a menstrual cycle that’s shorter than 27 days or a heavy menstrual flow that is longer than a week, you are at higher risk for endometriosis. Additionally, there is some evidence that shows women are at greater risk of developing the condition if a close family member (mother, sister, aunt or cousin) has it. Additionally, research suggests that women with endometriosis are more likely to have a height greater than 68 inches and to have a lower BMI.
Are certain groups more likely to have endometriosis?
White women are more likely to be diagnosed with endometriosis than Black women and Asian women. Those who have not given birth are also more likely to have the condition.
What are the treatment options for endometriosis?
The first line of treatment is painkillers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS), and hormonal birth control or progestin alone. Next comes long-term hormone therapy, which can reduce pain and slow the growth of endometrial implants. Surgery can also be performed to remove endometrial implants, which can reduce pain, but the implants can grow back. Laparoscopic surgery is considered the gold standard when it comes to surgical treatment for endometriosis.
Other surgical procedures include cutting pelvic nerves to reduce pain. If endometriosis worsens, an oophorectomy — a procedure that removes the ovaries — or a hysterectomy may be performed: Both procedures have also been shown to minimize or eliminate pain associated with endometriosis.
What other health conditions are related to endometriosis or can develop as a result of endometriosis?
Associated conditions include:
- interstitial cystitis, a chronic bladder condition
- TMJ, a condition that causes the jaw to lock
- inflammatory bowel disease
Endometriosis may also be associated with an increased risk of getting certain cancers, including:
- ovarian cancer
- endometrial cancer, a type of cancer that starts in the uterus
- non-Hodgkin’s lymphoma, a cancer that starts in the body’s lymphatic system
- melanoma, a type of skin cancer
How can endometriosis affect a woman’s fertility?
Some women with endometriosis can conceive and carry a baby to term. In fact, sometimes endometriosis is diagnosed visually during a cesarean section. In other cases, the tissue found outside the uterus, known as endometrial implants, causes inflammation, which can cause infertility or fertility problems. When implants attach to the fallopian tubes, they can lead to a delayed egg release and affect the body’s ability to transfer sperm to the released egg. In women with endometriosis-associated infertility, laparoscopic surgery and in vitro fertilization (IVF) can lead to improved pregnancy rates.
How can women improve their endometriosis symptoms?
Oral contraceptives can reduce the pain of endometriosis and prevent the endometrial cells from shedding and causing inflammation, limiting the growth of endometrial implants.
What are some alternative treatments or lifestyle changes women can make to help relieve symptoms of endometriosis?
The National Institutes of Health does not list any alternative treatments for endometriosis, but a 2018 study showed that acupuncture, yoga, exercise and electrotherapy may help relieve endometriosis-related pain.
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Hair Loss in Women
It was the winter of 1989 when I went bald.
And though I knew in advance I’d lose my hair from the chemotherapy to treat my breast cancer, nothing prepared me for the feeling of being stripped completely bare of a significant share of my identity. The chemotherapy rendered every last strand of my hair a psychologically painful afterthought.
Fortunately, a few months after the chemotherapy ended, so did my experience with baldness. Just as the buds were blooming with the promise of spring, downy-soft hairs sprinkled my scalp, and in no time, I had a full head of hair. I embraced and celebrated every last strand, feeling once again complete.
Today, decades later, I’m dealing with hair loss again. Thankfully, this time it’s age — and not chemotherapy — but the unexpected shedding still stings. It’s distressing to find fistfuls of hair left behind in a hairbrush or clogging a shower drain.
I’m in good (but unhappy) company: Hair loss affects about 1 in 3 women at some point in our lives. And while it’s natural to shed around 100 hairs a day, age and other factors have their own agenda and can speed up the loss while slowing down the gain.
To get to the root of the problem, we spoke to Elizabeth Liotta, M.D., a board-certified dermatologist and member of HealthyWomen’s Women’s Health Advisory Council, about hair loss and treatment options if you need help.
Who is affected by hair loss?
Any woman can be affected by hair thinning or loss, especially women over age 40, when hair growth slows and hair follicles eventually stop producing hair.
This can be really difficult. “As women, our hair is so important to our concept of beauty — hair loss or thinning is very traumatic,” Liotta said.
What causes hair loss in women?
There can be many different causes of hair loss for women. Besides aging and chemotherapy, other reasons include:
Androgenetic alopecia. This condition is known as female pattern baldness. It is a common form of hair loss that follows a specific pattern. In women, the pattern is a progressive widening of the area where you part your hair and thinning hair on the top and crown of the scalp.
Stress. Physical and emotional stress, including chronic illness, injury and relationship issues, can lead to temporary hair loss by coaxing the hair follicles into a “resting” phase, and stopping production of new hair strands. This is called telogen effluvium. “When the body is stressed, the phases of hair growth are shifted out of sync,” Liotta said.
Medications. For some people, hair thinning or loss can be a side effect of certain medications, which can include blood thinners, blood pressure meds and antidepressants.
Childbirth. After you give birth, your estrogen levels drop and your hair goes into the resting phase of growth. Hair shedding usually peaks about four months after giving birth, and for most women hair will grow back within a year.
Menopause or hormonal imbalances. Dropping levels of estrogen and progesterone can increase levels of androgens (male hormones). Shrinking hair follicles can cause hair to become finer, slow hair growth and speed up shedding.
Vitamin deficiencies. A lack of biotin, iron or zinc may affect hair follicles, leading to thinning or loss of hair.
Hair dyes and other hair processing agents. Over-processed hair is vulnerable to breakage, damage and subsequent loss.
Traction alopecia/traumatic alopecia. Over time, wearing your hair in tight braids or other styles that cause it to be pulled tightly away from the scalp can cause damage and loss. The great news: Your hair will usually grow back in once you change to a gentler form of styling.
Alopecia areata. This autoimmune condition is a skin disease where your body’s immune system attacks its hair follicles. Sometimes hair will regrow on its own, while other times corticosteroids or other treatments are necessary.
Read, “How I Learned to Love My Bald Self” >>
Thyroid disease. If your thyroid levels are too high (hyperthyroidism) or too low (hypothyroidism), it can cause hair loss. This type of hair loss is reversible if you treat the underlying condition.
Genetics. Both men and women can inherit hair loss genes that affect their hair follicles. The genes can come from your mother, father or both.
Covid hair loss. A prolonged bout with many illnesses, including Covid-19, can act as a stressor and push more hairs than normal into the shedding phase (known as telogen effluvium). Hair begins to fall out two to three months following the illness and the loss can last for six to nine months before it stops.
How can you tell what’s causing your hair loss?
Hair loss often has more than one reason. Because of that, Liotta suggests that a healthcare provider (HCP) should thoroughly evaluate you to figure out what’s going on.
They should look at your medical history, medications, nutritional status and hairdressing habits (dyes, gels, relaxers, hot irons) as well as give you a physical exam. In addition, blood tests and biopsies of your scalp can give your HCP a deeper look into what might be behind your thinning hair or baldness.
Hair loss treatments
While some hair loss may be cured or reversed, other times it may be permanent, depending on the cause. Hair loss treatments include:
- Topical or oral minoxidil
- Hair transplants
- JAK inhibitors
- Low-level laser therapy or platelet-rich plasma (PRP)
Do natural remedies for hair loss work?
Some people swear by natural hair loss supplements. Others stand by ingredients like saw palmetto, iron, onion juice or pumpkin seed oil. Some studies show promising results for natural remedies but the numbers are small, and more research is needed to know if they really work. It’s also important to note that too much of certain nutrients (like vitamins A and E and selenium) may actually cause hair loss.
If you’re concerned about losing your hair, try to treat it gently, eat a healthy diet and talk to your HCP for ideas and treatment options.
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How Psoriasis Affects Your Overall Well-Being
More than 7.5 million people in the United States live with psoriasis, a skin disease that causes scaly red patches all over the body — including on the face, hands, elbows and knees. Almost 6 out of 10 people with psoriasis have mental health issues such as depression and anxiety related to their disease.
One study found that psychiatric disorders are more common in people with skin conditions than in those with cancer, brain disorders and heart problems combined. And another found that women are much more likely than men to have these issues.
Because psoriasis symptoms are so visible, having this disease means dealing with the stigma attached to it. People with psoriasis can feel misunderstood or even made fun of by their peers and struggle with mental health challenges that can be far more painful than any physical symptoms.
Fear of rejection leads to isolation
“Most people with psoriasis experience anxiety and worry when it comes to their self-image,” said Mina Guirguis, M.D., a clinical psychologist at the Emotional Wellness Center for Skin Disorders. Guirguis specializes in psychodermatology, a branch of medicine that focuses on the effect of skin conditions such as psoriasis on mental health (and vice versa).
Guirguis said much of the anxiety experienced by people with psoriasis is related to what others will think of them. “Essentially, will others accept them for who they are or not,” he said. Fearing rejection, many choose to withdraw rather than face this fear. “They will often isolate or hide their skin condition,” Guirguis said.
This fear of rejection can seep into the daily life of a person with psoriasis, influencing every decision they make — especially when it comes to social interactions. “They might reject an invitation from coworkers to mingle after work,” Guirguis said. “They might find excuses not to go to the beach or put themselves in any situation where their skin condition might get unwanted attention from others.”
For people with psoriasis who are in a relationship, the damage the disease does to their self-image can make it hard for them to get close to their partner. “They might reject the partner’s advances due to feelings of being uncomfortable showing their bodies and the possibility of being rejected,” Guirguis said. “This in itself negatively affects the relationship and pushes them further apart.”
Stigma, misunderstanding surround psoriasis
Unfortunately, the anxiety people with psoriasis feel about how others will react to their condition isn’t always unfounded. Their mental health issues often stem from the way people who don’t understand the disease treat them — or mistreat them.
In a 2018 article on skin disorders and self-esteem published in the International Journal of Women’s Dermatology, one woman with psoriasis shared a story of being turned away from donating blood by a nurse who accused her of having the highly contagious fungal infection ringworm. She also described being forced by her boss at the bakery where she worked to wear long-sleeved shirts on even the hottest days after a customer accused her of purposely “shedding skin” on his cake.
In the same article, another woman said she stayed in an abusive relationship for almost a decade because her abuser told her no one else would ever love her with “all those things” on her skin. Both women went on to become patient advocates for the National Psoriasis Foundation, helping others cope with the physical and mental effects of the disease.
Sharing information to end stigma
Information is key to erasing the stigma around psoriasis. Helping people in your everyday life understand that psoriasis isn’t infectious or contagious, for example, can go a long way in changing the way they look at the disease — and those who have it. When we know better, we do better.
Guirguis believes it is also the responsibility of healthcare providers to help people understand skin conditions like psoriasis and their impacts on mental health. “I think mental health professionals along with dermatologists need to provide the public with education and correct any misconceptions about the illness,” he said.
Mental health professionals and dermatologists can also come together to help treat psoriasis holistically, dealing with both the physical and psychological effects. When physical symptoms are treated successfully, mental health often improves.
Self-acceptance and honesty are key to coping
When it comes to coping with psoriasis, Guirguis is a strong believer in coming to terms with the disease. “I often advise patients to work on accepting their skin condition,” he said. When people with psoriasis are able to accept their condition instead of hiding it, he said, they’re able to build their self-esteem and confidence.
“Acceptance of one’s condition and situation will help the patient free their minds of worrying how others will perceive them and whether they will be accepted by others or not,” Guirguis said. He encourages people with psoriasis to seek out a mental health professional who can help them work toward self-acceptance.
Some people with psoriasis may find exercise helpful for boosting their mood, especially if they’re dealing with depression. And a review of nine studies found physical activity can improve conditions such as heart disease and type 2 diabetes that often occur alongside psoriasis, providing a benefit to overall well-being.
Coping methods that reduce stress can also benefit the well-being of people with psoriasis. Calming practices such as yoga, mindfulness and meditation have all been shown to boost physical and mental health.
Sharing your struggles with psoriasis can also be very healing and creates the possibility of connection with others.
“Engaging in an honest conversation is always a start,” Guirguis said. “Share with others how your skin condition impacts your emotional as well as physical health. You are not going to succeed with having every loved one truly understand what you are experiencing, but you are opening their mind to understand your struggles.”
This resource was created with support from BMS.
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Dermatology Tips for Women of Color
We should all love the skin we’re in. While many women have the same goals regarding their skincare — from finding the right moisturizer to managing common skin conditions — women of color can have distinct concerns that aren’t always identified or treated correctly by healthcare providers.
We asked Lakshi Aldredge, MSN, ANP-BC, FAANP, a dermatology nurse practitioner for the VA Portland Health Care System and member of the HealthyWomen Women’s Health Advisory Council, to share some of her top dermatology tips for women of color to care for their bodies from head to toe.
1. Make sure to moisturize
While anyone can experience dry skin, a lack of moisture can be more noticeable on darker skin. Some studies suggest darker skin can also be more prone to dryness because it loses moisture faster than lighter skin. “I tell all patients it’s good to moisturize their skin, but in darker-skinned individuals, it makes such a difference in their skin’s appearance,” Aldredge said. “Also, the drier the skin, the itchier it gets.” Fragrance-free creams and ointments, or even petroleum jelly (except on the face) can help avoid dryness and related skin conditions.
2. Atopic dermatitis and psoriasis look different on skin of color
In lighter skin tones, inflammatory skin conditions such as psoriasis and atopic dermatitis look like red or pink patches, also called plaques. In darker skin tones, those patches may look brown, gray, dark gray, purple or even black. These patches also can look like older skin lesions, which may mean the condition is healing, but the disease is still active.
In people with darker skin, chronic, inflammatory skin conditions may also be misdiagnosed as scars, dry skin or even fungal infections. If you think you may have a skin condition, consider keeping a photo journal of the patches and lesions so your healthcare provider (HCP) can see how your skin is changing.
It’s also important to keep track of the timing of your skin issues. For example, did it occur suddenly or did it happen over months and years? It’s also a good idea to ask if other family members have similar skin conditions and, if so, what treatments worked for them.
3. Treat inflammatory skin conditions like atopic dermatitis and psoriasis as soon as possible
The sooner you get diagnosed, the easier it is to treat inflammatory skin conditions. At-home treatments include taking lukewarm baths using mild soaps and then immediately moisturizing with plain petroleum jelly or other non-perfumed moisturizers. For more severe cases, people can look into more advanced non-steroidal treatments from a dermatologist.
4. Release the tension
Cornrows, braids, beads and other cultural hair care practices among people of African descent should be celebrated, but pulling hair too tightly can lead to hair loss. Traction alopecia, for example, is a type of hair loss often seen in Black women. If you choose to wear braids or similar styles, try to minimize the tension and the tightness, Aldredge said. Other practices, such as bleaching and chemical straightening, can lead to hair damage, hair thinning and even contact dermatitis in the scalp as a result of reactions to the chemicals.
5. Watch for skin changes
If you see new markings on your skin or existing ones start to change size, shape or color, contact your HCP to make sure they’re not an early sign of something more serious. “If you do have a new rash, think about when it started or what you were doing that may have been associated with it,” Aldredge said. “Were you traveling? Did you start any new medications? Any new pets? Bug bites? Is there anyone else in the household or close contacts who have a similar rash or lesion? Getting a good history of the skin issue will be very helpful for your dermatology provider or your primary care provider to help narrow down a diagnosis.”
6. Understand that skin conditions can present in different locations in darker-skinned individuals
Skin cancer is a significant example of how conditions can appear different by race — melanoma rates are lower in people with darker skin because of their higher melanin content, which protects against sun damage. When it does occur, it tends to appear on the palms, soles and nails versus the scalp, face, back or trunk in fairer-skinned people. “Bob Marley died of melanoma and it started in his toenail,” Aldredge said. “That’s the classic example.”
7. Find an HCP familiar with treating darker skin
Sometimes, skin conditions can go undiagnosed on darker skin because of their different appearance. That makes it important to find a provider who knows what to look for in patients with darker skin. The American Academy of Dermatology allows users to search for “skin of color” in their provider search. Other resources include the Skin of Color Society and the Black Derm Directory.
This resource was created with support from Eli Lilly.