Vitamin D Deficiency

Vitamin D Defiynciency is something that can affect anyoine despite age, gender, or ethnicity.  The likelihood of it developing does depend on several factors, however.  It is said thet someone is Vitamin D Deficient when the amount of Vitamusein D is inadequate which may have health consequences (Yale, 2025).  Vitamin D is important for the process of the body, including bone, to absorb Calcium, Phosphorous, and Magnesium.  Vitamin D Deficiency causes these to no be absorbed well.  Vitamin D also plays an essential role in the nervous, musculoskeletal and immune systems (Cleveland Clinic, 2022).  Vitamin D Deficiency can also be linked to  increased risk of:

• Cancer
• Heart Disease
• Stroke
• Depression
• Muscular Sclerosis
• Type 2 Diabetes (Watson, 2024)

There are several things that may contribute to someone developing Vitamin D Deficiency.  These include:

• Not enough exposure to sunlight
• Darker skin Pigment
• Malnutrition
• Kidney or Liver failure
• Certain medications
• Certain cancers
• Family history of  Vitamin D Deficiency orh Childhood Rickets
• Chorn's Disease, Cystic Fibrosis, and Celiac Disease
• Obesity
• Weight Loss Surgery (Yale, 2025)(Watson, 2024)

There are also some risk factors to developing Vitamin D Deficiency including:

• Age - 65 years old or older
• BMI greater or equal to 30
• Melanated skin
• Smoking
• Not eating foods fortified with Vitamin D (Watson, 2024).

Although  the signs and symptoms may be more obvious in kids, there are also signs and symptoms in adults as well.  In kids, signs and symptoms include:

• Weak, sore, painful muscles
• Incorrerct growth (bowed or bent legs)
• Muscle weakness
• Bone pain
• Joint deficiencies (Watson, 2024)

In adults, signs and symptoms include:

• Fatigue
• Bone and joint pain
• Muscle weakness, aches, or cramps
• Increased sensitivity to pain
• "Pins and needles" sensations in hands and feet
• Muscle spasms
• Waddling while walking due to muscle weakness i n hips and legs
• History of broken bones
• Mood changes (Yale, 2022)(Watson, 2024)

You may be wondering how much vitamin D people need each day.  Well, it is age dependant.

• Birth to 12 months - 400 IU
• 1-13 years - 600 IU
• 14 - 18 years - 600 IU
• 19 - 70 years - 600 IU
• 71 - older - 800 IU
• Breastfeeding or pregnant - 600 IU (Medline Plus, 2024)

Who are individuals who may be at risk for Vitamin D Deficiency?

• Breastfed infants - breast milk is low in vitamin D.  Infants who are sole breast fed should be given a vitamin D supplement equal to 400 IU every day.
• Older adults - skin does not make vitamin D as efficient as it did when someone is younger.  Also, Kidneys do not convert vitamin D to its active form as well.
• People with increased melenation (darker skin) - darker skin has decreased ability to produce vitamin D when exposed to sunlight.  
• People dealing with Obesity - body fat binds sone vitamin D which decreases the amount available in the blood stream.  Increased body fat binds more vitamin D removing more vitamin D from bloodstream.
• People who have had Gastric Bypass Surgery - this surgery bypasses part of small intestine where vitamin D is absorbed.  Having part of the small intestine bypassed affects absorption of vitamin D.
• People with Chronic Kidney or Liver Dizease - affects ability to change vitamin D into active form.
• People taking certain medications - certain cholesterol, anti-seizure and weight loss medications can affect vitamin D level. 
• People with Cystic Fibrosis, Chrohn's Dizease, and Celiac Disease - these conditions prevent vitamin absorption in intestines.
• People who do not spend a lot of time in the sun.  (Medline Plus, 2024)(Cleveland Clinic, 2022)

There is a blood test that can be done to determine vitamin D levels.  Those individuals who are at risk for Vitamin D Deficiency can have a 25 - hydroxyvitamin D [25(OH)D] blood test done (Watson, 2024).

Once Vitamin D Deficiency has been diagnosed, there are ways that it can be treated.

• Foods that naturally have vitamin D include:
• Fatty Fish - salmon, tuna, markel and sardines
• Rainbow Trout
• Beef liver
• Mushrooms
• Egg yolks
• Cod liver oil
• Foods that are often fortified with vitamin D include:
• Cow's, soy, almond and oat milk
• Breakfast cereals
• Orange juice
• Dairy products
• Vitamin D supplements may be taken.

Your healthcare provider should be consulted to determine the best way to increase vitamin D levels if deficient (Medline Plus, 2024).

What happens if you have too much vitamin D?

Although not common, it is possible to concume too much vitamin D, primarily through supplements.  Signs and symptoms of vitamin D toxicity include:

• Nausea
• Increased thirst and urination
• Poor Appetite
• Constipation
• Weakness
• Confusion
• Ataxia - impaired balance or coordination
• Dysarthria - unclear speech
• Irregular heartbeat
• Kidney Failure (Medline Plus, 2024)

Cleveland Clinic, (2022)  Vitamin D Deficiency.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency#diagnosis-and-tests

Medline Plus. (2024)  Vitamin D Deficiency.  Medline Plus.  Retrieved from https://medlineplus.gov/vitaminddeficiency.html

Watson, L. (2024)  Vitamin D Deficiency.  WebMD.  Retrieved from https://www.webmd.com/diet/vitamin-d-deficiency

Yale. (2025) Vitamin D Deficiency.  Yale University.  Retrieved from https://www.yalemedicine.org/conditions/vitamin-d-deficiency

Sleep Hygiene

What is Sleep Hygiene you may ask?

Sleep Hygiene is a group of healthy sleep habits that can improve your sleep.  Good sleep hygiene can improve overall health.  

How does good sleep hygiene improve health?

Some benefits of having good sleep hygiene and obtaining adequate, good quality sleep include:

• Your body having the ability to repair itself, particularly the heart and blood vessels
• Boost of immune system
• Supports hunger hormone balance
• Supports regulated insulin levels
• Supports health growth and development
• Decreases risk of conditions such as heart disease, High Blood Pressure, obesity, Diabetes and stroke
• Helps to maintain a healthy weight
• Emotional and cognitive renewal
• Decreases stress
• Lower risk of motor vehicle crashes
• Improves attention and memory (Solodar, 2025)(CDC, 2024)(NIH,2022)

What can you do to have better sleep hygiene?

There are behaviors you can incorporate and habits you can develop to increase the quaility of your sleep.  These include:

• Make your sleep environment comfortable - keep bedroom  quiet, relaxing and at a cool temperature
• Maintain a consistent sleep schedule -try to go to sleep at the same time every day
• Turn off electronic devices at least 30 minutes before bedtime
• Follow a bedtime routine that helps you fall asleep
• Exercise regularly - even 30 minutes of aerobic exercise can increase sleep quality      
• Avoid lage meals and alcohol before bedtime
• Avoid caffeine in afternoon or evening - effects of caffeine can last 3 - 7 hours
• Avoid smoking - Nicotine is a stimulant
• Limit napping
• Manage stress
• Manage light exposure (Solodar, 2025)(CDC, 2024)(Healthline, 2024)

What is meant by sleep quality?

Quality sleep encompases not only how many hours you sleep, but also how well you sleep.  Poor sleep quality may include:

• Trouble falling asleep
• Waking up during the night
• Feeling sleepy or tired after a full night's sleep (CDC, 2024)

What are some common sleep disorders?

• Insomnia - trouble or staying asleep 
• Restless Legs Syndrome (Willis - Ekbom Disease) - neurological condition causing  irresistible urge to move legs
• Narcolepsy - chronic disorder causing someone to be very sleepy during day hours and disrupts night sleep.  Individual may fall asleep during daily activities
• Sleep Apnea - condition where breathing stops and restarts many times (NIH, 2022)(NIH, 2022) (NIH, 2025)(NIH, 2025)(NIH, 2025)

According to the CDC, the following is how much sleep is recommended for each age group every day:

• 0 - 3 months:    14 - 17 hours
• 4 - 12 months:   12 - 16 hours
• 1 - 2 years:  11 - 14 hours
• 3 - 5 years:   10 - 13 hours
• 6 - 12 years:  9 - 12 hours
• 13 - 17 years:  8 - 10 hours
• 18 - 60 years:  7 or more hours
• 61 - 64 years: 7 - 9 hours
• 65 years and older:  7 -8 hours (2024)

To find Sleep Hygiene resources, visit the National Sleep Foundation's website at:  

https://www.thensf.org/sleep-health-topics/

CDC. (2024)  About Sleep.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/sleep/about/index.html

Healthline. (2024)  12 Tips For Better Sleep Hygiene.  Healthline.  Retrieved from https://www.healthline.com/health/sleep-hygiene

NIH (2022)  Insomnia:  What is Insomnia?   National Heart, Blood and Lung Institute.   Retrieved from https://www.nhlbi.nih.gov/health/insomnia

NIH (2022)  Sleep Deprevention and Deficiency:  How Sleep affects Your Health.   National Heart, Blood and Lung Institute.Retrieved from https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

NIH. (2025) Narcolepsy.   National Heart, Blood and Lung Institute.  Retrieved from https://www.nhlbi.nih.gov/health/narcolepsy

NIH. (2025)  Restless Leg Syndrome.  National Institute of Neurological Disorders and Stroke.   Retrieved from https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome

NIH (2025) Sleep Apnea:  What is Sleep Apnea.  National Heart, Blood and Lung Institute.  Retrieved from https://www.nhlbi.nih.gov/health/sleep-apnea

Solodar. (2025)  Sleep Hygeine: Simple practices for better rest.  Harvard Health Publishing.  Retrieved from https://www.health.harvard.edu/staying-healthy/sleep-hygiene-simple-practices-for-better-rest

Distracted Driving

Distracted driving is when an activi takes away a driver's attention while driving.  These activities can be:

Visual - taking your eyes off the road

Manual - taking your hands off the wheel

Cognitive - taking your mind off driving (CDC, 2024).

Texting while driving is a common distraction.  Either sending or reading a text can take someoone's eyes off the road for five seconds.  If someone is driving 55 MPH, the distance driven can be the legnth of a football field (NHTSA, n.d.).  Other examples of activities that can be distracting while driving are talking on a cell phone, using a GPS, or eating.  

In 2019, more than 3,100 people were killed and approximately 424,000 people werre injured in the United States in motor vehicle accidents involving a distracted driver (CDC, 2024).  This equates to nine people in the United States every day being killed in a motor vehicle accident involving a distracted driver (CDC, 2024).  When looking at motor vehicle accidents involving distracted drivers, there is a higher percentage of drivers ages 15 - 20 than those 21 and older.  Of fatal crashes among drivers 15 - 20 years old, 9% were distracted at the time of the crashes (CDC, 2024).  When surveyed, 39% of high school students stated that they had either texted or emailed at least once in the past 30 days while driving (CDC, 2024).

There are ways to prevent distracted driving.  There are many states that enacted laws in order to prevent distracted driving to include banning texting while driving, hands free laws and limiting the number of young passangers riding with teen drivers (CDC, 2024).  Physical alerts, such as rumble strips, are installed in some states in order to alert individuals when drowsy or distracted (CDC, 2024).  Federally, the United States Department of Transportation released the National Roadway Safety Strategy in 2022 to support vehicle technology to detect distracted driving.  President Obama issued an Executive Order in 2009 that prohibits federal employees either texting while driving a government owned vehivle or while on government business.  Additionally, commercial vehicle drivers were banned from texting while driving in 2010 by the Federal Motor Carrier Safety Administration (CDC, 2024). 

 In order to learn state laws concerning distracting driving where you live, visit the Governor's Highway Safety Association.  The National Highway Travel Safety Administration provides education concerning distracted driving, develop campaigns and Public Service Announcements, partner with states and local police to enforece laws (NHTSA, n.d.).

CDC. (2024).  Distracted Driving.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/distracted-driving/prevention/index.html

NHTSA. (N.D.)  Distracted Driving.  National Highway Travel Safety Administration.  Retrieved from https://www.nhtsa.gov/risky-driving/distracted-driving

Stroke

 Stroke is a condition of blood arteries goint to and in the brain, in which, becomes blocked and the blood supply is no longer to transverse the artery.  As the blood does not reach its intended brain cells, the cells begin to die due to the lack of oxygen within minutes (CDC, 2023)(Cleveland Clinic, 2023).  Globally, stroke is the second most common cause of death (Cleveland Clinic, 2023).  Stroke is additionally a leading cause of disability.

There are two types of strokes: Ischemic stroke and Hemorragic stroke.  A Transient Ischemic Attack (TIA), which are at times referred to as mini strokes, are medical emergencies as are stokes, however, are differentiated from strokes as it lasts for five minutes or less (CDC, 2023).  Ischemic strokes occurs when either blood clots, fatty deposits (plaques), or other particles block the blood arteries (CDC, 2023).  These types of strokes account for 87% of strokes (ASA, 2023).  Hemorrhagic strokes occur when a blood artery ryptures or leaks blood and accounts for 13% of strokes (CDC, 2023)(ASA, 2023).  Two types of blood vessel malformations that can cause hemorragic strokes are aneurysms and arteriovenous malformations (AVMs) (ASA, 2023).  Uncontrolled hypertention is the most common cause of hemorrhagic stroke.  Hemorrhagic strokes can be either intracerebral, within the brain, or subarachnoid, between the inner and outer layer of dura that covers the brain (ASA, 2023).

Because death to brain cells can occur within minutes, it is important to recognize the signs and symptoms of stroke quickly and obtain treatment even quicker.  Symptoms of stroke include:

• Trouble speaking
• Trouble understanding what people are saying
• Paralysis or numbness of face, arm or leg
• Loss of muscle control on one side of face
• Blurry or blackened vision
• Sudden partial or total loss of one or more of senses
• Neck stiffness
• Emotional instability
• Dizzines
• Nausea
• Vomiting (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

There are several risk factors for stroke.  They can be divided into Lifestyle, Medical and other types of risk factors and include:

• Lifestyle
• Obesity
• Physical inactivity
• Heavy or binge drinking
• Illegal drug use
• Medical
• Hypertension
• High Cholesterol
• Smoking
• Second hand smoke exposure
• Diabetes
• Obstructive Sleep Apnea
• Cardiovascular Disease
• Personal or family history of stroke
• COVID - 19 infection
• Clotting Disorders
• Atrial Fibrillation
• Migraine Headaches - there is an increased risk with migraines, especially if migraines are preceeded by auras
• Other
• Age - people 55 years of age and older are at greater risk
• Race or ethnicity -  African Americans and Hispanics have a greater risk
• Sex - men have a higher risk than women
• Hormones -  birth control pills or hormonal therapy with estrogen can increase risk (Mayo Clinic, 2023)(Cleveland Clinic, 2023)

Once diagnosed, it is important to treat a stroke as quickly as possible.  Regardless of what type of stroke is being treated, Blood Pressure management should be part of the treatment plan.  When treating an Ischemic Stroke, it is important to restore blood flow to the brain.  For Ischemic Strokes, treatments include:

• tissue plasminogen activator (TPA) - must be given within 4 1/2 hours from the start of symptoms.  Helps to dissolve blood clot.
• Emergency Endovascular procedures - medications can be delivered directly to the brain through a catheter that is inserted into the artery in order to deliver the medication directly to where the stroke is occuring,
• Removing clot with stent remover - useful with large clots and can be done with or without TPA
• Carotid Endarterectomy - removes plaques that are specifically blocking carotid arteries
• Angioplasty and stents - catheter is inserted into artery.  Stent can be placed to help support section of narrowed artery that was expanded.  (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

With Hemmorhagic strokes, treatments include:

• Blood thining medications
• Medications to decrease pressure in the brain
• Surgery -  with large bleeds, blood vessels may be repaired
• Surgical Clipping - clamps can be placed the base of aneurysms to stop blood flowing to it
• Surgical AVM removal - when accesible, smaller AVMs can be removed
• Stereotactic Radiosurgery - multiple beams of highly focused radiation can be used to repair blood vessel malformations (Cleveland Clinic, 2023)(Mayo Clinic, 2023).

Once someone has had a stroke, they may experience complications, such as:

• Paralysis - particularly on one side
• Difficulty talking or swallowing - stroke can affect mouth and throat muscles
• Memory Loss
• Emotional Problems - may have difficulty in controlling emotions and/or develop depression
• Pain - pain and/or numbness may occur in parts of body associated with locations in the brain that were affected by the locations in the brain that were affected by the stroke
• Changes in behavior and self-care ability (Mayo Clinic, 2023)

There are things people can do to try to prevent strokes, including:

• Controlling hypertension
• Lowering cholesterol and saturated fat intake
• Quitting smoking and other tobacco use
• Managing Diabetes
• Maintaining a healthy weight
• Eating fruits and vegetables
• Regular exercise
• Limit alcohol intake
• Treat Obstructive Sleep Apnea
• Avoid illegal drugs

Attached is the Cleveland Clinic's FAST reminder card.

For more information on stroke, visit one of the three references below.

ASA. (2023) About Stroke.  American Stroke Association.  Retrieved form https://www.stroke.org/en/about-stroke

Cleveland Clinic. (2023)  Stroke.  Cleveland Clinc.  Retrieved from https://my.clevelandclinic.org/health/diseases/5601-stroke#symptoms-and-causes

Mayo Clinic (2023) Stroke.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Menopause

 Menopause is a phase within a woman's reproductive cycle where there have been twelve consecutive months without a mentrual cycle.  Menopause can occur naturally or be the result of surgery (where the ovaries and/or uterus is removed), chemotherapy, radiation therapy, or primary ovarial insufficiency (Mayo, 2023).  Although menopause can occur during your 40s or 50s, the average age for menopause to occur is 51 (Mayo, 2023).

When occurring naturally, ovaries stop producing estrogen and progesterone.  It is a gradual process that occurs in stages.  The first stage is perimenopause that can begin anywhere between eight to ten years before monopause.  During this period, estrogen and progesterone are produced at different levels and decrease durin this period.  The next period is menopause where the  ovaries cease to release eggs and producing estrogen for twelve consecutive months.  During this time, women tend to have increased symptoms.  The last stage is postmenopause.  In this stage, symptoms decrease and there is an increased risk of certain health conditions such as osteoporosis, stroke, and heart disease (Cleveland Clinic, 2023)(OASH, 2023(Duke, 2023).

There are many signs and symptoms of menopause to include:

• Hot flashes (vasomotor symptoms) - sudden feeling of warmth that encompasses the entire body
• Night sweats
• Cold flashes
• Vaginal dryness
• Urinary urgency
• Urinary Tract Infections
• Insomnia
• Emotional changes - irritability, mood swings, anxiety
• Dry skin
• Dry eyes
• Dry mouth
• Racing heart rate
• Weight gain
• Joint and muscle aches
• Difficulty concentrating
• Changes in libido
• Breast tenderness
• Increasing symptoms of PMS
• Irregular periods
• Hair loss (Cleveland Clinic, 2023)

These symotoms can occur over the span of several years.

Menopause is diagnosed after twelve months without a menstrual cycle.  Some blood tests may be helpful when menstruation is or becomes irregular such as:

• Estrogen levels
• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormones (LH) (Medline, 2020)

There are several treatments available for menopause including:

• Hormone therapy - can replace hormones that ovaries no longer make.  Helps symptoms like hot flashes and vaginal dryness.  Can also help to prevent Osteoporosis.
• Estrogen therapy (ET) - can be used only with women that have had their uterus removed.  There is a risk with ET when used with women who still have their uterus in tact of endometrial cancer.
• Hormone Thereapy with both Estrogen and Progesterone (EPT) - can be used with women  who still have their uterus in tact.
• Risks of hormone therapy include:
• Gallstones
• Deep Vein Thrombosis
• Pulmonary Embolism
• Stroke
• Risks are lower when therapy is started within 10 years of menopause
• Non Hormonal therapy 
• Changing diet - limit caffiene and spicy foods
• Avoiding triggers of hot flashes
• keep bedroom cool at night
• Quitting smoking
• Losing weight
• Excercise - can help with insomnia
• Support groups - outlet for emotions
• Anti-depressants - can manage mood swings 
• Gabepentin - decreases hot flashes
• Clonidine - decreases hot flashes
• Fezolinetant - decreases hot flashes
• Medications to prevent or treat Osteoporosis (Mayo, 2023)

Although women who are in the post menopausal phase are not able to get pregnant, they should still take precautions to practice safe sex, such as using condoms, in order to protecct themselves from sexual transmitted diseases.  If a woman experiences vaginal bleeding after menopause, she should seek medical attention as it can be a sign of serious medical conditions including:

• Endometrial or vaginal atrophy
• Uterine or endometrial cancer
• Endometrial hyperplasia
• Uterine polyps
• Cervical cancer
• Cervicitis
• Endometritis (Cleveland Clinic, 2023)

Cleveland Clinic. (2023)  Menopause. Cleveland Clinc. Retrieved from https://my.clevelandclinic.org/health/diseases/21841-menopause#symptoms-and-causes

Cleveland Clinic. Post-Menopausal Bleeding.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

Duke. (2023) Menopause Treatment. Duke. Retrieved from https://www.dukehealth.org/treatments/obstetrics-and-gynecology/menopause?utm_source=google&utm_medium=cpc&cr=obgyn_treatments&utm_campaign=OB+GYN+-+Condition+-+NB&keyword=menopause&gclid=Cj0KCQjw6cKiBhD5ARIsAKXUdybehANc9eRjm6npusX8I1nH28VI6GXo5RbOovSGFWttSkfbp807hMsaArDjEALw_wcB

Mayo Clinic. (2023)  Menopause.  Mayo Clilnic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

Medline. (2023) Menopause.  Medline Plus.  Retrieved from https://medlineplus.gov/menopause.html

NIH. (2023) What are the symptpms of menopause.  National Institutes of Health.   Retrieved from https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/symptoms

OASH. (2023)  Menopause.  Office of Women's Health.  Retrieved from https://www.womenshealth.gov/menopause/menopause-basics

Endometriosis

 Endometriosis is a condition that affects the female reproductive system.  It is estimated that up to 10% of women between the ages of 15 and 44 suffer from endometriosis (John Hopkins, 2023).  Typically, every month, the endometrium lines the uterus in preparation for a potential pregnancy (fertilized egg).  If a fertilized egg does not implant into the endometrium, then it is broken down and shed during a women's menses (monthly period).  In the case of endometriosis, the endometrium grows outside the uterus and can involve the ovaries, fallopian tubes, and pelvis (Mayo Clinic, 2018).  Regardless of whether inside or outside the  uterus, the endometrium is broken down each month.  When inside the uterus, the endometrium exits the uterus through the cervix and the vagina.  With Endometriosis, there is no exit point for the endometrium and it therefore is trapped (Mayo Clinic, 2018).  This can cause tissues to become irritated and therefore scar tissue or adhesions may develop.  Adhesions occur when fibrous tissues create bands that cause organs and tissues to stick together (Mayo Clinic, 2018).  

The cause of Endometriosis has not conclusively been determined (John Hopkins, 2023).  Some possible causes include:

• Retrograde Menstruation-  menstrual blood flows backwards through the fallopian tubes
• Transformation of peritoneal cells -  hormonal factors cause peritoneal cells to transform into endometrial cells
• Embryonic cell transformation - hormones cause embryonic cells (present in early development) to transform into endometrial like cells and to implant into the pelvis during puberty
• Surgical scar Implantation - endometrial cells may attach to surgical scar after surgeries such as a cesarian section 
• Endometrial cell transport -  endometrial cells are transported through blood vessels or lymphatic system 
• Direct transplantation:  after an abdominal surgery, endometrial cells may attach themselves to other parts of the body(Mayo Clinic, 2018)(John Hopkins, 2023)

Locations that Endometriosis can occur include:

• Fallopian tubes
• Ovaries
• Vagina
• Peritoneum
• Bladder and Ureters
• Intestines
• Rectum
• Diaphragm (Cleveland Clinic, 2022)

There are several risk factors for Endometrosis.  They include:

• age
• family history
• race
• having never given birth
• early age of menarche (start of period)(before 11 years old)
• going through menopause at older age
• short menstrual cycles
• heavy menstrual cycles
• high levels of estrogen
• low BMI
• one or more relative with Endometriosis
• other reproductive tract disorders (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline, 2021)

A few things that can reduce the risk of endometriosis.  They include:

• pregnency
• breastfeeding
• healthy weight
• mestrual period starting at a later age (Cleveland Clinic, 2022)

Signs and symptoms of endometriosis include:

• painful menstrual cramps
• abdominal or back pain during or between periods
• pain during sex
• heavy bleeding during period
• spotting between periods
• infertility
• bloating
• lower back pain
• Painful bowel movements
• diarrhea
• constipation
• nausea (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline,  2021)

There are several tools used to diagnose Endometriosis including a medical history and physical exam which includes a pelvic exam.  A procedure that can provide a definite diagnosis is a laparoscopy where a thin tube that has a camera attached on the end is inserted through a small insertion ad is used to remove any suspicious tissue (John Hopkins, 2023).  Other tests that may also be helpful include:

• ultrasound - creates an image of internal organs
• CT scan - creates images of successive planes of the body
• MRI - creates a two dimensional view of internal organs (Mayo Clinic, 2018)(John Hopkins, 2023)

There are several options for the treatment of Endometiosis.  The options include both medications or surgery.  The options include:

• NSAIDS:  can be used for pain relief
• Hormone Therapy: can be used to reduce or eliminate pain through slowing the growth of endometrial lining and preventing implantation of endometrial tissue
• Hormonal Contraceptives:  control the hormones involved in endometrial tissue building up
• Gonadotropin-releasing hormone (Gn-RH) agonists and  antagonists:  these drugs  block ovarian stimulating hormones from being produced.  With these drugs, endometrial tissue can shrink.
• Progestin therapy: progestin can relieve the signs and symptoms by halting periods and halting endometrial implants from growing.  Therapies may be delivered through intrauterine deices, implants or injections
• Aromatase inhibitors:  reduce estrogen
• Surgery:  endometriosis implants can be removed either laporoscopically or abdominally.  A hysterectomy to include the ovaries may also be done.
• Fertility treatment:  range from ovary stimulation in order to produce eggs to in vitro fertilization. (Mayo Clinic, 2018)

For more information watch our video

For more information, go to the Mayo Clinic website:

https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cleveland Clinic. (2022)  Endometriosis.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/10857-endometriosis

Healthline. (2021)  Endometriosis.  Healthline.  Retrieved from https://www.healthline.com/health/endometriosis#Takeaway

John Hopkins Medicine. (2023)  Endometriosis.  John Hopkins Medicine.  Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

Mayo Clinic. (2018)  Endometriosis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cervical Cancer

The cervix is part of the female reproductive system and is located at the base of the Uterus and is connected to the vagina.  Cancer, regardless of where it occurs in the body, occurs when cells grow out of control.  There may not be symptoms of cervical cancer initially.  When symptoms do occur, they can include:

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during sex
• Pelvic pain
• With advanced disease:
• Swelling in legs
• Blood in urine
• Problems with urination and defecation
• Kidney failure
• Bone pain
• Weight loss
• Lack of appetite
• Fatigue (WebMD, 2021)(ACS, 2020)

There are several risk factors for Cervical Cancer.  Human Papillomavirus (HPV) is a risk factor for Cervical Cancer.  HPV is a virus spread through sexual contact.  Most women who contract HPV do not develop Cervical Cancer, however, there are several strains of  that can cause Cervical Cancer (Medline, 2021)(Mayo, 2021).  Other risk factors include:

• Many sexual partners - increases potential exposure to HPV.  Increased number of partners increases risk.
• Early sexual activity - the younger a woman is when she initiates sexual activity, the increased exposure, potentially, to an increased number of partners.
• Other sexually transmitted infections 
• Weakened immune system - due to diminished ability to fight infections
• Smoking
• Exposure to miscarriage prevention drug, diethylstilbestrol
• Using Birth Control Pills for more than 5 years - risk decreases after stopping use
• Giving birth to more than 3 children - due to possible increased exposure.  Studies also show that hormonal changes during pregnancy may possibly make women more susceptible.
• Young age with first full term pregnancy 
• Economic status - can affect a woman's access to health care.
• Diet - a diet low in fruits and vegetables increases risk
• Family history (ACS, 2020)(Medline Plus, 2021)(CDC, 2021)(Mayo Clinic, 2021)(WebMD, 2021)

There are several types of Cervical Cancer.  These types include:

• Squamous Cell Carcinoma - occurs in the squamous cells that line the cervix on the portion projecting into the vagina.  Makes up approximately 90% of cases.
• Adenocarcinoma - occurs in glandular cells in the cervical canal that produce mucous.
• Mixed carcinoma - has features of both Squamous Cell Carcinoma and Adenocarcinoma.  (WebMD, 2021)(Mayo Clinic, 2021).

In order for Cervical Cancer to be diagnosed, certain tests can be performed.  The primary test to screen for Cervical Cancer is the Pap Smear.  The Pap Smear involves obtaining cells from the cervix in order to detect precancerous or cancerous cells.  Another screening test that can be helpful is an HPV test (Mayo Clinic, 2021).  After these screening tests are performed, if Cervical Cancer is suspected, other tests can be done to confirm the diagnosis.  These tests include:

• Colposcopy - colposcope (magnifying instrument) is used to help identify abnormal cells in cervix,
• Punch Biopsy - can be performed with Colposcopy and small samples are removed from the cervix for examination.
• Endocervical Curettage - either a small spoon shaped instrument or a brush scrapes a cervical sample for examination.
• Electrical Wire Loop - low voltage electrified wire is used to remove a sample of tissue for examination.
• Cone Biopsy - deeper layers of cervix are removed as a cone shaped sample to include the transformation zone.  This is the boundary between the exocervix (outer layer of cervix) and endocervix (inner layer of cervix).  It is in this zone that precancerous cells and cancers are most likely to be found and begin.
• Loop Electrosurgical Excursion Procedure (LEEP) -  a wire loop, heated by electricity, is used to remove a tissue sample for examination (ACS, 2020)(Mayo Clinic, 2021)(WebMD, 2021).

Once Cervical Cancer is diagnosed, tests can be performed to assess whether the cancer has metastasized, or moved to other areas of the body.  These tests may include:

• Cystoscopy: - tube with lens and light is inserted into bladder to assess cells.
• Proctoscopy - a tube with light is inserted into rectum to inspect visually.
• Imaging studies 
• Chest X-ray - used to view the lungs
• Computed Tomography (CT Scan) - used to find larger tumors and looking for metastasis
• Magnetic Resonance Imaging (MRI) - examines soft tissues
• Positron Emission Tomography (PET Scan) -  radioactive sugar is injected into blood where it will collect in cancer cells.  When used with CT scan can produce detailed picture (Mayo Clinic, 2021)(ACS, 2020)

After diagnosis, treatments are available.  Which treatments are used may depend on how far along the cancer is, or which stage it is.  When Cervical Cancer is diagnosed and treated early, the survival rate is high.  If cell changes are found before the become cancerous (precancerous), with treatment, the survival rate is almost 100%.  For stage 0, the survival rate is 90%.  In Stage I, the survival rate is 80-93%.  Once Cervical Cancer reaches stage II, survival drops to 58-63%.  Stage III survival is 32-35% and Stage IV survival rate is 16% (WebMD,  2021).  Treatments include:

• Cone Biopsy - technique used for diagnosis can also be used as treatment when cancer is early
• Cryosurgery -  cold probe freezes cells, killing them
• Laser Ablation - laser is used to vaporize abnormal cells
• Surgery - typically with early stages where the cancer is removed.
• Trachelectomy -  removal of  cervix and upper vagina
• Hysterectomy - uterus and cervix are removed.  Ovaries and lymph nodes may or may not be removed.
• Chemotherapy - medications are used to kill cancer cells
• Targeted Therapy -  medication therapy focuses on the weaknesses of the cancer cells, killing them.
• Radiation - high powered beams kill cancer cells.
• Immunotherapy - Medications that help immune system attack cancer cells (ACS, 2020)(Mayo Clinic, 2021).

There are ways to protect yourself from Cervical Cancer.  First, limit the number of sexual partners.  This limits exposure to HPV.  Routinely be screened for Cervical Cancer with Pap Smears and HPV.  Also, don't smoke.  If you currently smoke, take steps to quit.

If you have been diagnosed with Cervical Cancer, use this link to an American Cancer Society website for resources:  https://www.cancer.org/treatment/understanding-your-diagnosis.html

ACS. (2020)  About Cervical Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/cervical-cancer/about.html

CDC. (2021)  Basic Information About Cervical Cancer.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/cancer/cervical/basic_info/index.htm

Mayo Clinic. (2021) Cervical Cancer.  Mayo clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

Medline Plus. (2021)  Cervical Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/cervicalcancer.html#cat_92

WebMD. (2021)  Cervical Cancer.  WebMD.  Retrieved from https://www.webmd.com/cancer/cervical-cancer/cervical-cancer