Does Inflammation Contribute to Premenstrual Symptoms?
Alicia Armeli

pms

It’s that time of the month again. And no, we’re not talking about your period. We’re talking about the week or two before your period when symptoms like mood swings, cravings, and relentless back pain and breast tenderness make their way into your everyday life. Premenstrual Syndrome or PMS is a common condition that affects around 80% of reproductive aged women.1 Despite its frequency, studies have yet to identify its underlying cause.

Nearly half of these women seek medical care for PMS and often rely on anti-inflammatory medicines to tame symptoms.1 Researchers at the University of California Davis School of Medicine used this link to further investigate the potential relationship between inflammation and PMS. They found that women who suffered from PMS symptoms were more likely to have higher levels of a particular circulating inflammatory molecule called high-sensitivity C-reactive protein (hs-CRP).1

Gold, Wells, and Rasor of the Department of Public Health Sciences analyzed data taken from the Study of Women’s Health Across the Nation (SWAN)—a long-term study made up of almost 3000 racially and ethnically diverse women.1 Using this information, they looked at hs-CRP levels to see if they correlated with PMS symptoms.

Results published earlier this year in the Journal of Women’s Health showed that women with elevated hs-CRP (levels greater than 3 mg/L) were more likely to experience PMS symptoms such as changes in mood, cramping, back pain, food cravings, weight gain, bloating, and breast tenderness.

Although producing inflammatory proteins like hs-CRP is the body’s natural immune response to inflammation, it’s also considered to be an integral part of a woman’s monthly cycle. In healthy women with normal menstrual cycles, inflammatory protein levels are seen to increase around ovulation and later peak during menstruation—a time some consider to be a naturally inflammatory monthly episode.2 These higher inflammatory protein levels coincide with menstruation’s low estrogen and progesterone levels, further showing that the body’s immune response is a normal part of a woman’s cycle.2

To a certain extent, fluctuations in inflammatory markers during the menstrual cycle are normal. But when these fluctuations extend beyond normal levels—as Gold and her team observed—they can affect menstrual and PMS symptom severity. Earlier research papers have linked inflammatory protein levels, specifically CRP, to period symptom severity, with the strongest association seen in mood and pain symptoms.2 Other studies have shown similar results with inflammatory proteins called interleukins to be connected to both period and PMS severity.2

More studies are needed to confirm how inflammation exactly influences PMS, but these preliminary findings could potentially impact how the condition is treated and possibly play a role in prevention.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

REFERENCES

  1. Gold, E. B., Wells, C., & Rasor, M. O. (2016). The association of inflammation with premenstrual symptoms. Journal of Women’s Health, 25(9): 865-874. doi: 10.1089/jwh.2015.5529. http://online.liebertpub.com/doi/abs/10.1089/jwh.2015.5529?src=recsys
  1. Bertone-Johnson, E. R., Ronnenberg, A. G., Houghton, S. C., Nobles, C., Zagarins, S. E., Takashima-Uebelhoer, B. B., Faraj, J. L., & Whitcomb, B. W. (2014). Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women. Human Reproduction, 29(9): 1987-1994. doi: 10.1093/humrep/deu170. http://humrep.oxfordjournals.org/content/29/9/1987.full.pdf+html
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Fibroids, Your Thyroid, and Food—What’s the Connection?
Alicia Armeli

thyroid

Thyroid disorders occur more frequently in women, with one in eight developing a thyroid disorder in her lifetime.1 Researchers at the Medical University of Vienna found that hypothyroidism, also known as underactive thyroid, could be linked to another common condition—uterine fibroids.

The Austrian retrospective study conducted by Walch et al. included 215 women who had undergone hysterectomy between January 2007 and January 2011.2 All uterine fibroids initially detected by ultrasound were verified during surgery.

Results published in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that 51 women (23.7%) were found to have fibroids.2  The authors noted that common factors like African American ethnicity and increasing age were associated with fibroid risk. But upon further analysis, they found an additional factor that hasn’t been so steadily researched—hypothyroidism.

Women with hypothyroidism were seen to be three times more likely to have fibroids, especially larger fibroids, in comparison to women without hypothyroidism.2  Given these findings, Walch and her team concluded that hypothyroidism could be linked to fibroids.

Uterine fibroids—a type of noncancerous tumor that grows in the uterine wall—are believed to affect most American women. According to some research, 70% of white women and 80% of black women have fibroids by the time they reach 50.3 In many women, fibroids are asymptomatic. But for others, they can be the cause of heavy painful periods, pelvic pressure, and infertility.

Factors that increase the risk of fibroids include African American ethnicity and age—as Walch and her team verified—as well as family history and obesity.4 Although factors like these may have a genetic component, some research points to controllable factors like dietary habits that could influence fibroid risk. It’s suggested that a diet heavy in green vegetables may protect women from developing fibroids.4

And yet, many of the same greens that are recommended to prevent fibroids are the same ones that can slow down thyroid function. For example, cruciferous vegetables—think broccoli, kale, Brussels sprouts, etc.—have naturally occurring substances called goitrin. Goitrin can interfere with the production of thyroid hormones, but is found mainly to be a concern only when paired with iodine deficiency.5

Should these healthy foods be avoided?

If you have hypothyroidism, cruciferous vegetables don’t need to be dismissed entirely from your favorite food list but may need to be limited and should be cooked before eaten. Cooking methods such as steaming or microwaving can partially neutralize goitrin, reducing its effects.5 Recruiting the help of your doctor and a dietitian can help you find the right balance and also make you more familiar with potential food-medication interactions.

Developing fibroids and hypothyroidism may be unavoidable. But learning more about your risk, as well as related health and lifestyle factors, can help you regain control.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

REFERENCES

  1. American Thyroid Association. (2016). General Information/Press Room. Retrieved October 25, 2016, from http://www.thyroid.org/media-main/about-hypothyroidism/
  1. Ott, J., Kurz, C., Braun, R., Promberger, R., Seemann, R., Vytiska-Binstorfer, E., & Walch, K. (2014). Overt hypothyroidism is associated with the presence of uterine leiomyoma: a retrospective analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 177: 19-22. doi: 10.1016/j.ejogrb.2014.03.003. http://www.ejog.org/article/S0301-2115(14)00135-3/abstract
  1. US Department of Health and Human Services. (2013). Uterine Fibroids. Retrieved October 26, 2016, from https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=50
  1. Office On Women’s Health, US Department of Health and Human Services. (2015). Uterine Fibroid Fact Sheet. Retrieved October 26, 2015, from https://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
  1. Harris, C. (2012). Thyroid Disease and Diet—Nutrition Plays a Part in Maintaining Thyroid Health. Today’s Dietitian, 14(7): 40. Retrieved October 26, 2016, from http://www.todaysdietitian.com/newarchives/070112p40.shtml
Going Straight to the Source: Study Asks Women What Treatment Works Best for Uterine Fibroids
Alicia Armeli

compareufstudy

A national multi-center study aims to determine which uterine fibroid treatments are most effective. But instead of seeking answers from doctors, researchers are collecting data from an unexpected yet powerful source—real women living with the condition.

“Women wanted answers to questions that addressed treatment effectiveness in terms of symptom relief and effects on future fertility,” says Dr. Evan R. Myers, MD, MPH, Professor of Obstetrics and Gynecology at Duke University School of Medicine and the Duke Clinical Research Institute, and the study’s Principal Investigator. “One of the things that’s become clear over the past few years as patients have been participating in developing research programs is that, particularly for this condition where hysterectomy is one of the potential treatments, women wanted more control over the treatment they chose. They were more interested in being part of a registry—or observational study—rather than a randomized trial.

The 5-year study entitled, Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) seeks to understand which fibroid treatment options work best by observing factors that influence treatment outcomes.

Funded in 2014 with a $20 million grant from the Patient-Centered Outcomes Research Institute (PCORI) administered by the Agency for Healthcare Research and Quality (AHRQ), researchers hope to recruit thousands of women from nine different clinical centers across the nation.  After collecting pre-treatment information about medical history and symptoms, participating women will answer specific questions about which treatments they chose and how well these treatments are working at annual intervals.

This direct line of questioning is essential because uterine fibroids are unique to each woman—making a one-size-fits-all approach to treatment impossible. Fibroids affect as many as 3 out of 4 women, with African American women being most at risk.1 And although these tumors are noncancerous, they grow in different sizes, numbers, and locations within the uterine wall and can be the cause of an array of symptoms like pelvic pain and pressure, heavy bleeding, incontinence, and infertility. To treat such symptoms, an estimated 30%-50% of women with fibroids seek treatment.2

Instead of seeing these differences among women as obstacles, the COMPARE-UF team considers them an asset to their research and the key to targeting the most advantageous treatment options.

Dr. Myers explains that by proactively gathering and examining images of what a woman’s uterus looked like before a procedure, it’s possible to illustrate how varying factors—like fibroid size and location—could influence the outcome of a procedure.  “To be able to compare treatment outcomes, we really need to know how women are different in terms of symptoms and uterine anatomy before they underwent a procedure. That’s something you just can’t tell from administrative records or most common databases.”

What’s more, COMPARE-UF is looking for factors, including hormones, that may predict the impact of specific treatments for individual women. For example, anti-mullerian hormone (AMH) levels can be a good predictor of when a woman will undergo menopause. “Knowing ahead of time might be very useful,” Dr. Myers tells Ask4UFE. “Some procedures can cause ovarian aging and make menopause happen sooner. Having this information in advance could be useful in terms of helping women decide which procedure is right given where they are in life.”

Currently, COMPARE-UF sites include University of Mississippi Medical Center, Department of Defense Clinical Consortium, Mayo Clinic Collaborative Network, University of California Fibroid Network, Henry Ford Health System, University of North Carolina, Brigham and Women/Harvard Clinical Center, Inova Health Systems, and University of Michigan.

Utilizing a wide range of medical centers offers patient diversity, differences in procedure availability, and access to various levels of healthcare coverage. This variety will help tackle questions about health disparities existing among women with fibroids that have gone unanswered.

“Not having access to quality healthcare is a problem,” Dr. Myers continues. “One of the questions that’s tough to answer, in terms of the disparities for fibroids, is how much of it is due to biological differences and how much of it may be due to differences in access to care. By including sites, like Department of Defense medical centers, where access to healthcare isn’t a problem, we’re able to begin to address  these questions.”

In the future, the COMPARE-UF team hopes to expand the study by adding more sites and even making enrollment open to women anywhere in the nation simply by registering online. Also, by potentially extending the length of the study, more long-term data regarding pregnancy outcomes and fibroid recurrence can be collected.

“Fibroids are a burden with immense quality of life implications. And still we don’t know much about how to treat it,” Dr. Myers reports. ”We’re hoping to be able to give better information to women about the likelihood of what to expect with different procedures, given their unique situation and options available to them. Our ultimate goal is to collect information that’s going to help women decide what’s best for them.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

ABOUT THE DOCTOR  Evan R. Myers, MD, MPH, is the Walter L. Thomas Professor of Obstetrics and Gynecology at Duke University School of Medicine and Principal Investigator of COMPARE-UF. His research encompasses a number of women’s health issues, including cancer prevention and treatment, pregnancy complications, and uterine fibroids. Through his work, Dr. Myers strives to ensure women are able to make informed treatment decisions.

REFERENCES

  1. COMPARE-UF. (2016). Welcome to COMPARE. Retrieved October 3, 2016, from http://compare-uf.org/welcome-to-compare/
  1. Soliman, A. M., Yang, H., Du, E. X., Kelkar, S. S., & Winkel, C. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. American Journal of Obstetrics and Gynecology, 213(2): 141-160. doi: 10.1016/j.ajog.2015.03.019
Metabolic Syndrome Linked to Uterine Fibroid Risk
Alicia Armeli

waistline

Nearly 35% of all US adults have metabolic syndrome, also known as syndrome X—a condition made up of different cardiovascular disease risk factors that collectively increase the likelihood of chronic diseases like diabetes, heart disease, and stroke.1 And according to a recent British and Finnish study, metabolic syndrome could also increase the risk of uterine fibroids.2

Fibroids are common noncancerous tumors that grow in the wall of the uterus. Exceedingly common, they affect up to 80 percent of women by age 50 and can cause heavy painful periods, pelvic pressure, frequent urination, and infertility.3

To better understand underlying causes of fibroids, researchers at the University of Oxford and the University of Oulu, used health data from over 3000 women who participated in The Northern Finland Birth Cohort—a population-based prospective study that included all individuals born in 1966 in the Northern Finland area. All women included in the study underwent extensive clinical health exams at age 46 and completed health questionnaires by mail.

The results were presented earlier this year at the 32nd Annual European Society of Human Reproduction and Embryology in Helsinki, Finland, and showed that as triglyceride and LDL cholesterol (often referred to as the “bad” cholesterol”) levels rose, so did the risk of fibroids. The authors also noticed that fibroid risk climbed with each centimeter of expanding waistline. High triglyceride levels and a large waistline are both recognized criteria of metabolic syndrome.

Other signs of metabolic syndrome include high blood pressure, high fasting blood sugar levels, and low HDL cholesterol (often referred to as the “good” cholesterol). A person must have at least three co-occurring risk factors to be diagnosed with metabolic syndrome.

Although LDL cholesterol isn’t listed as a sign of metabolic syndrome, in this study it was connected to fibroid risk. It’s also linked to heart disease. LDL cholesterol contributes to the plaque that sticks to and hardens artery walls—a condition known as atherosclerosis that disproportionately affects women with fibroids.4,5

Studies have shown that—in comparison to women who are fibroid-free—women with fibroids have thicker arteries and low HDL cholesterol levels.5 HDL cholesterol helps remove LDL cholesterol from arteries. In addition to changes in artery thickness, low HDL cholesterol levels increase the risk of atherosclerosis.5

Uncontrollable factors like age and genetics impact cholesterol levels and can contribute to developing metabolic syndrome.6,7 However, we also know these conditions are tightly associated with being overweight and physical inactivity—factors that are also linked with an increased risk of uterine fibroids.3,6,8,9

New findings in the field of fibroids and metabolic disease offer researchers a unique reciprocity of valuable information. In hopes of finding a cure, data surrounding metabolic risk factors can be used to better understand the underlying causes of fibroids. At the same time, these risk factors can be used as a tool to detect and prevent chronic conditions, like heart disease, among high-risk populations.

Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

REFERENCES

  1. American Medical Association. (2015). Study Finds High Prevalence of Metabolic Syndrome in U.S. Retrieved September 25, 2016, from http://media.jamanetwork.com/news-item/study-finds-high-prevalence-of-metabolic-syndrome-in-u-s/
  1. Unavadis. (2016). Lipids and metabolic syndrome associated with increased risk of uterine fibroids—European Society of Human Reproduction and Embryology Conference Essentials. Retrieved September 25, 2016, from http://www.univadis.com/viewarticle/lipids-and-metabolic-syndrome-associated-with-increased-risk-of-uterine-fibroids-eshre-421519
  1. Office on Women’s Health, US Department of Health and Human Services. (2015). Uterine Fibroids Fact Sheet. Retrieved September 26, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
  1. American Heart Association. (2014). Good vs. Bad Cholesterol. Retrieved September 27, 2016, from http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Good-vs-Bad-Cholesterol_UCM_305561_Article.jsp#.V-qYnccuL0g
  1. Aksoy, Y., Sivri, N., Karaoz, B., Sayin, C., & Yetkin, E. (2014). Carotid intima-media thickness: a new marker of patients with uterine leiomyoma. European Journal of Obstetrics & Gynecology and Reproductive Biology, 175: 54-57. doi:10.1016/j.ejogrb.2014.01.005
  1. National Institutes of Health—Medline Plus. (2012). Cholesterol Levels: What You Need to Know. Retrieved September 27, 2016, from https://medlineplus.gov/magazine/issues/summer12/articles/summer12pg6-7.html
  1. Mayo Clinic. (2016). Metabolic Syndrome: Symptoms and Causes. Retrieved September 27, 2016, from http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/dxc-20197520
  1. US Department of Health and Human Services, National Heart, Lung, and Blood Institute. (2016). What Is Metabolic Syndrome? http://www.nhlbi.nih.gov/health/health-topics/topics/ms
  1. He, Y., Zeng, Q., Dong, S., Qin, L., Li, G., & Wang, P. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity, and stress: a case-control study in China. Asia Pacific Journal of Clinical Nutrition, 22(1): 109-117. doi:10.6133/apjcn.2013.22.1.07