You may already be aware that heart disease is the leading cause of death for men and women in the United States. But what you may not know is that cardiovascular disease is not only impacted by factors such as genetics, obesity, or smoking, but also by menopause and andropause.
The use of hormones to offset the effects of menopause/andropause is an option, but first, we have to clarify why they have had a bad reputation, and what medical research is now showing.
Hormone replacement therapy is bad!?
The belief that menopausal women shouldn’t take hormone replacements stemmed from a 2002 study by the Women’s Health Initiative (WHI). Using conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) for the study, the researchers determined that the benefits of HRT were greatly outweighed by the detrimental effects it had on breast and heart health.
But a later analysis of the 2002 WHI trial and newer studies have shown that use of HRT in younger or early postmenopausal women was not as concerning as previously thought and that HRT has a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality.
In December 2020, the American Heart Association (AHA) revised its guidelines and now states that the transition of menopause itself, independent of chronological and ovarian aging, leads to increased cardiovascular risk and mortality.
Less than two years later, the European Society of Cardiology issued a release stating that hormonal changes during menopause are directly related to a decline in cardiovascular health. The announcement referred to a new study that linked hormonal changes during menopause to metabolic alterations that promote heart disease.
Menopausal HRT plays a positive role in the lipid profiles of postmenopausal women. Two 2022 studies showed HRT significantly decreased the levels of total cholesterol, LDL-C, and Lp(a) compared with placebo or no treatment and improved most of the cardiovascular risk factors such as obesity, lipid profiles, blood sugar levels, and arterial hypertension.
So…HRT is good?
The American Heart Association’s updated 2020 clinical recommendations focused on the role of lifestyle interventions—such as eating healthily and exercising, using lipid-lowering medications when needed, and taking hormone replacement therapy (HRT)—for the prevention of cardiovascular disease in menopausal women.
Bottom line: Hormone replacement therapy initiated early among patients with premature or surgical menopause and within 10 years of natural menopause is associated with cardiovascular benefit. The magnitude and type of HRT-associated risks, including breast cancer, stroke, and venous thromboembolism are rare (<10 events per 10,000 women), not unique to HRT, and comparable with other medications.
What about men?
Low hormone levels affect the guys, too. After forty, men’s testosterone levels typically begin to decrease and as a result, the risks for all-cause mortality and cardiovascular health increase. Low T levels in men may increase risk of developing coronary artery disease (CAD), metabolic syndrome, obesity, and type 2 diabetes.
But which hormones are best?
Different formulations, doses, and routes of delivery of hormone therapy have different effects on cardiometabolic markers and cardiovascular risk. For example, transdermal estrogens have less effect on blood clotting, inflammation, lipids, and triglyceride concentrations than oral estrogens, and they pose a lower risk of venous thromboembolism and stroke than oral estrogens. Micronized progesterone has no effect on the risk of venous thromboembolism, whereas other progestogens and progestins cause an increase in risk.
Your compounding pharmacist can work with you and your healthcare provider to test your hormone levels to figure out which ones need replacing. Using that information, along with your bothersome symptoms, your compounding pharmacist can work with your prescriber to create a customized hormone replacement therapy that is right for you.
- Iyer TK, Hirsch H. Clinical impact of 2020 American Heart Association statement on menopause and cardiovascular disease risk. Cleve Clin J Med. 2022 Jan 4;89(1):13-17. doi: 10.3949/ccjm.89a.21031. PMID: 34983797.
- Hormonal changes during menopause are directly related to decline in cardiovascular health. EurekAlert. News release. May 13, 2022. Accessed May 13, 2022. https://www.eurekalert.org/news-releases/952200
- Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas). 2019;55(9):602. Published 2019 Sep 18. doi:10.3390/medicina55090602
- Hodis HN, Mack WJ. Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It Is About Time and Timing. Cancer J. 2022 May-Jun 01;28(3):208-223. doi: 10.1097/PPO.0000000000000591. PMID: 35594469; PMCID: PMC9178928.
- Correspondence to Dr Ritu Thamman, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; email@example.com http://dx.doi.org/10.1136/heartjnl-2020-318390 Statistics from Altmetric.com https://heart.bmj.com/content/107/14/1106.long
- Armeni E, Lambrinoudaki I. Androgens and cardiovascular disease in women and men. Maturitas. 2017 Oct;104:54-72. doi: 10.1016/j.maturitas.2017.07.010. Epub 2017 Jul 29. PMID: 28923177.
- Çatakoğlu AB, Kendirci M. Testosterone replacement therapy and cardiovascular events. Turk Kardiyol Dern Ars. 2017 Oct;45(7):664-672. Doi: 10.5543/tkda.2017.00531. PMID: 28990951.
- Goodale T, Sadhu A, Petak S, Robbins R. Testosterone and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):68-72. doi: 10.14797/mdcj-13-2-68. PMID: 28740585; PMCID: PMC5512682.
- Corona G, Torres LO, Maggi M. Testosterone Therapy: What We Have Learned From Trials. J Sex Med. 2020 Mar;17(3):447-460. doi: 10.1016/j.jsxm.2019.11.270. Epub 2020 Jan 9. PMID: 31928918.
- Kharaba ZJ, Buabeid MA, Ibrahim NA, Jirjees FJ, Obaidi HJA, Kaddaha A, Khajehkarimoddini L, Alfoteih Y. Testosterone therapy in hypogonadal patients and the associated risks of cardiovascular events. Biomed Pharmacother. 2020 Sep;129:110423. doi: 10.1016/j.biopha.2020.110423. Epub 2020 Jun 20. PMID: 32570122.
- Anagnostis P, Paschou SA, Katsiki N, Krikidis D, Lambrinoudaki I, Goulis DG. Menopausal Hormone Therapy and Cardiovascular Risk: Where are we Now? Curr Vasc Pharmacol. 2019;17(6):564-572. doi: 10.2174/1570161116666180709095348. PMID: 29984659.
- Shufelt CL, Manson JE. Menopausal Hormone Therapy and Cardiovascular Disease: The Role of Formulation, Dose, and Route of Delivery. J Clin Endocrinol Metab. 2021 Apr 23;106(5):1245-1254. doi: 10.1210/clinem/dgab042. PMID: 33506261; PMCID: PMC8063246.
- Anagnostis P, Lambrinoudaki I, Stevenson JC, Goulis DG. Menopause-associated risk of cardiovascular disease. Endocr Connect. 2022 Apr 22;11(4):e210537. doi: 10.1530/EC-21-0537. PMID: 35258483; PMCID: PMC9066596. https://pubmed.ncbi.nlm.nih.gov/35258483/
- Nie G, Yang X, Wang Y, Liang W, Li X, Luo Q, Yang H, Liu J, Wang J, Guo Q, Yu Q, Liang X. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Front Pharmacol. 2022 Apr 12;13:850815. doi: 10.3389/fphar.2022.850815. PMID: 35496275; PMCID: PMC9039020. https://pubmed.ncbi.nlm.nih.gov/35496275/
- Bińkowska M. Menopausal hormone therapy and venous thromboembolism. Prz Menopauzalny. 2014 Oct;13(5):267-72. doi: 10.5114/pm.2014.46468. Epub 2014 Nov 2. PMID: 26327865; PMCID: PMC4520375.
- Sobel TH, Shen W. Transdermal estrogen therapy in menopausal women at increased risk for thrombotic events: a scoping review. Menopause. 2022 Jan 14;29(4):483-490. doi: 10.1097/GME.0000000000001938. PMID: 35357370. https://pubmed.ncbi.nlm.nih.gov/35357370/
- Gialeraki A, Valsami S, Pittaras T, Panayiotakopoulos G, Politou M. Oral Contraceptives and HRT Risk of Thrombosis. Clin Appl Thromb Hemost. 2018 Mar;24(2):217-225. doi: 10.1177/1076029616683802. Epub 2017 Jan 4. PMID: 28049361; PMCID: PMC6714678. Stephenson K, Neuenschwander PF, Kurdowska AK. The effects of compounded bioidentical transdermal hormone therapy on hemostatic, inflammatory, immune factors; cardiovascular biomarkers; quality-of-life measures; and health outcomes in perimenopausal and postmenopausal women. Int J Pharm Compd. 2013 Jan-Feb;17(1):74-85. PMID: 23627249. https://pubmed.ncbi.nlm.nih.gov/23627249/
- Holtorf, Kent. Postgraduate Medicine, Volume 121, Issue 1, January 2009, ISSN – 0032‐ 5481, e‐ISSN – 1941‐9260. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? https://pubmed.ncbi.nlm.nih.gov/19179815/
- Plu-Bureau G, Mounier-Vehier C. Traitement hormonal de ménopause et risque cardiovasculaire. RPC Les femmes ménopausées du CNGOF et du GEMVi [Menopausal hormone therapy an cardiovascular risk. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. Gynecol Obstet Fertil Senol. 2021 May;49(5):438-447. French. doi: 10.1016/j.gofs.2021.03.017. Epub 2021 Mar 20. PMID: 33757923.


Facts about Alcohol-Related Liver Disease
As noted by the American Liver Foundation, alcohol-related liver disease is a “common, but preventable disease” caused by “excessive consumption of alcohol.” There are three types of liver disease caused by excessive alcohol consumption:
- Fatty liver
- Alcoholic hepatitis
- Alcohol-related cirrhosis
If caught early enough, liver damage may be reversed if a person stops drinking. Otherwise, most heavy drinkers will develop some form of liver cancer. The most common alcohol-related liver disorder is fatty liver. It is when an excess of fat builds up around the liver. The condition is preventable, as are all other forms of alcohol-related liver disease and can be reversed through abstinence from alcohol.
Continued heavy alcohol consumption can lead to alcoholic hepatitis. “Alcoholic hepatitis is an inflammation, or swelling, of the liver accompanied by the destruction of liver cells.” Complications from this form of liver disease can be life-threatening. Over 1/3 of heavy drinkers will develop alcoholic hepatitis.
The most severe form of alcohol-related liver disease is alcohol-related cirrhosis. Cirrhosis occurs when nonliving scar tissue replaces healthy liver tissue. People who have been drinking heavily for 10 years or more are at a greater risk for developing alcohol-related cirrhosis. Symptoms of this disease can be fatal including high blood pressure in the liver, bleeding from veins in the esophagus and an accumulation of fluid in the abdomen.
If you suspect you have liver damage, you should be seen by a doctor immediately. Stopping drinking may help reverse some of the effects that alcohol can have on the liver. It is important to speak with a medical professional if you are a heavy drinker or engage in binge drinking regularly.


Doctor Sagi Arnoff
Neurosurgeon of the Highest Qualification Category
Doctor Sagi Arnoff is one of the world’s largest specialists in the field of neurosurgery, which owns all the modern technology in his speciality. Besides, he conducts a scientific activity, publishes numerous scientific articles and participates in international symposia in the area of neurosurgery.
- Neurosurgeon of the Highest Qualification Category.
- Correction of facial bones and the skull, endoscopic skull base and pituitary surgeries.
- Treatment of aneurysms, vascular defects, cavernous malformations, intracranial haemorrhage.
- Treatment of benign tumors.
- Trigeminal neuralgia surgery (Fothergill’s disease).
- Brain vessels surgeries.
- 2007 – till present time: Neurosurgeon and Deputy Head of the Neurosurgery Department.
- 2005 – 2007: MD-PhD student at the Department of Cerebrovascular Diseases Diagnosis and Treatment at the University of Virginia School of Medicine.
- 1998-2004: neurosurgeon and an Emergency Room Physician, then a senior neurosurgeon.
- Graduated from Tel-Aviv University Sackler Faculty of Medicine.
- Specialization in the largest Israeli clinic “Sheba Medical Center”.
- Training in the clinic at the University of Pittsburgh (USA).
- Training in Barcelona clinic – specialization in endoscopic neurosurgery.
- Training in Virginia University (USA) during two years, where he specialised in the diagnosis and treatment of diseases associated with the brain vessels.
Academic work experience
- 2007 – present: Visiting Professor at the University of Virginia Medical Faculty, USA.
- Dr. Sagi Arnoff is the author and co-author of a large number of scientific papers and articles published in peer-reviewed scientific journals of neurosurgery.
Memberships in professional organizations
- Member of the European Research Network on Intracerebral Haemorrhage (EURONICH).
- The honorary member of Focused Ultrasound (FUS) Foundation, which develops treatments using image-guided focused ultrasound.
- Member of Israel Neurosurgical Society.


In traditional oriental medicine, the term “organ” refers both to the physical organ and the energetic functions related to that organ. There are 12 main organs in traditional oriental medicine, each has a Um and Yang pair, as shown in the table below. Um OrganYang Organ Lung Large Intestine Spleen Stomach Heart Small Intestine Kidney Bladder Pericardium Triple Warmer Liver Gall Bladder Extraordinary Meridians Conception Vessel Governing Vessel
The Ki flow through the twelve main meridians is as follows:
Lung → Large Intestine → Stomach → Spleen
Heart → Small Intestine → Bladder → Kidney
Pericardium → Triple Warmer → Gall Bladder → Liver
Each of the twelve main meridians is arranged in one of three meridian circuits. The energy in each meridian circuit follows a path of Chest → Hand → Face → Foot → Chest. For example, the first circuit is the Lung → Large Intestine → Stomach → Spleen. In this case, the lung transfers Ki from the chest out to the hand, the large intestine transfers Ki from the hand to the face, the stomach transfers Ki from the face to the foot, and the spleen transfers Ki from the foot back to the chest.
Thinking of the energetic functions of an organ greatly enhances the understanding of Ki Gong. Primary energetic functions for a variety of organs are shown in the table below. OrganEnergetic Functions Lung Governing Ki and controlling respiration Controlling, disseminating, and descending Regulating the water passages Houses the emotional animal mind/spirit Spleen Produces Ki and Blood from food Controls Blood (holds blood in the vessels) Controls Raising Ki Houses intellectual mind/spirit Heart Governs blood and blood vessels House the spirit (seen in complexion) Governs sweating Kidney Stores Chung (essence) and dominates reproduction, growth and development Produces bone marrow Dominates water Controls the reception of Ki Houses the will power mind/spirit Liver Stores Blood Maintains free flow of Ki (seen in nails) Houses the aspect of mind associated with higher order emotions love, trust, integrity, wisdom Stomach Controls rotting and ripening of food Controls descending
In addition to the stomach, which is described in the table above, the function of other Yang organs relates to the separation of nutrients and waste. Problems with Yang organs can result in pain in the distribution of that organ’s meridian and/or eventual dysfunction in its Um-related organ.


Acid Reflux/Gastroesophageal Reflux Disease (GERD)
Acid reflux, also known as gastroesophageal reflux, occurs when the stomach contents back up (or reflux) into the esophagus and mouth. Reflux is
a normal process that typically does not cause complications. However, people with gastroesophageal reflux disease (GERD) experience bothersome
symptoms as a result of the reflux.
Symptoms can include heartburn, regurgitation, vomiting, and difficulty or pain with swallowing. The reflux of stomach acid can adversely affect
the vocal cords, causing hoarseness, or even inhaled into the lungs. Click here to view lifestyle changes that can help control symptoms of GERD.
Treatment usually begins with over-the-counter medications to control acid. If you do not experience relief within a few weeks, your doctor may
recommend other treatments, including prescription medications or surgery.


Stinging nettles in a nutshell:
- They lose their sting in the first 30 seconds of cooking.
- They have more protein than any other edible plant I know of
- They will satisfy my hamburger cravings.
- Harvest for eating before they are knee high.
- The seeds and roots have medicinal value.
- In the fall they can be used to make cordage – especially good for water cordage, like nets hence the name.
- Possibly the easiest plant food to dry and save for later
Read more and see more videos via Permies.com: stinging nettles: harvesting, eating, cooking.
- Stinging Nettle Recipes Beyond Soup & Tea (eatdrinkbetter.com)
- Foraging Gourmet Cuisine From Nature’s Bounty (readyforanythingstore.net)
- Stinging Nettle Pesto (marksdailyapple.com)


June is Alzheimer’s and Brain Awareness Month. According to Alzheimer’s Association’s report, there are 6.5 million Americans who are living with Alzheimer’s disease, the number is expected to reach 13 million by 2050. Most older adults who are older than age 65 are living with Alzheimer’s disease, however, Alzheimer’s disease is not considered a normal part of aging. Hence, not all older adults who are above age 65 will develop Alzheimer’s disease. As a matter of fact, some adults who are younger than age 65 can develop Alzheimer’s disease as well, it is called early-onset Alzheimer’s.
Many older adults with Alzheimer’s disease may not be aware of their symptoms. Research has shown that individuals with Alzheimer’s disease may experience damage to the brain that starts a decade before symptoms show. The table below indicates the behavioral and personality changes of Alzheimer’s disease in different stages:
|Mild Alzheimer’s Disease
|Moderate Alzheimer’s Disease
|Severe Alzheimer’s Disease
|Increased memory loss and confusion
|Inability to communicate
|Poorer judgment that can cause bad decisions
|Inability to learn new things
|Shortened attention span
|Losing things or misplacing items
|Difficulty organizing thoughts
|Taking longer time to complete tasks
|Difficulty recognizing family and friends
|Increased anxiety and/or aggression
|Restlessness, anxiety, tearfulness, agitation
|Groaning, grunting, or moaning
|Tendency to wander and get lost
|Hallucinations, delusions, and paranoia
|Loss of bowel and bladder control
|Starting to show mood and personality changes
|Difficulty carrying out multistep tasks
Early-Onset Alzheimer’s Disease
While Alzheimer’s disease may be a common medical condition for many older adults, the uncommon form of dementia that affects people who are younger than age 65 is considered early-onset Alzheimer’s. There are about 5% to 6% of people experience young-onset Alzheimer’s symptoms between age 30 and 60. Although research still has not found a reliable explanation to prove the causes of young-onset Alzheimer’s disease, researchers have found that it is very unlikely (could still be possible) that young-onset Alzheimer’s disease is caused by genetic factors. Individuals who have a family history of Alzheimer’s disease do not necessarily indicate that there is a gene mutation that could cause Alzheimer’s disease in future generations. On the other hand, a lack of family history of Alzheimer’s disease does not prevent individuals to not developing early-onset Alzheimer’s disease either.
The symptoms of early-onset Alzheimer’s disease closely mirror the symptoms of other forms of Alzheimer’s disease:
- Forgetting important dates and things
- Repetitively asking for the same information
- Misplacing things and not being able to retrace steps to find things
- Noticing changes in mood and personality
- Losing track of time/location/date
Unfortunately, experts are not entirely sure if there is an actual way to prevent Alzheimer’s disease, it is recommended to look for any of the early warning signs and seek professional consultation from your healthcare provider. However, there are other treatments and lifestyle changes that can be made to slow down the progress of early-onset Alzheimer’s disease. Research has identified several risk factors for Alzheimer’s disease to look out for, these include high body mass index (BMI), depression, stress, diabetes, and smoking. Many studies also mentioned that lifestyle factors are shown to correlate with a reduction in Alzheimer’s disease rates, but no proven Alzheimer’s prevention strategies are found.
To slow down the progress of early-onset Alzheimer’s disease, here are some ways you can consider:
Increase physical activity
- Researchers found that higher physical activity is linked to less cognitive decline. At least 150 minutes per week of moderate to vigorous-intensity physical activity are recommended. Physical activity plays a significant role in one’s health, as well as emphasizing the importance of healthy aging.
Change of diet
- Nutrition pairs well with physical activity; studies have shown that the combination of both can potentially change the trajectory of developing cognitive impairment and dementia. Some recommended diets that have well-known health benefits are Mediterranean and DASH, which are designed to help slow brain decline.
- Brain-Healthy Food that you should add to your plates includes green leafy vegetables, whole grains, fish, olive oil, nuts, berries, and beans.
- Combinations of Foods that may increase the risk of developing Alzheimer’s symptoms: sugary snacks, starches (i.e. potato), processed meat
Engage in strength-building activities
- Activities that can build your strength tend to work your major muscles, which helps to control the sugar level in your blood and reduce the risk of diabetes. It is recommended to do strength-building activities on at least two or more days each week. Strength-building activities to consider are yoga, Tai Chi, dancing, lifting weights (which could be heavy objects in the home), heavy gardening, push-ups, and sit-ups.
Keep yourself mentally and socially active
- Stress and depression are two risk factors mentioned that could lead to Alzheimer’s disease, hence, it is important to engage in mental and social activities to build up the brain ability to cope with stress and improve mood.
- Find activities that can challenge your brain and do them regularly to provide mental stimulation. Consider trying puzzles, crosswords, quizzes, card games, and board games. Other activities that require your creativity and are good for the brain include arts and crafts, reading books, and creative writing/journaling.
- Social activities are good for the brain; when you have a conversation with someone, it helps to exercise a range of your mental skills. Some conversational actions that involve mind engagement are actively listening, expressing empathy, evaluating people’s words, and recalling things when it’s your turn to share.
For more information on Early-onset Alzheimer’s:
By: Jessica Lau, MHC


Backed by Congressional legislation, the Endometriosis Research Center is again celebrating March as “Endometriosis Awareness Month” in honor of all those affected by the disease. I'm not a doctor, but I do suffer from this disease, and I have done my research. This is just a post to tell you what Endometriosis is, in hopes that I might be able to help you or somebody that you know.
What is endometriosis?
Endometriosis is the growth of cells similar to those that form the inside of the uterus (endometrial cells), but in a location outside of the uterus. Endometrial cells are the same cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. These implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants, while they can cause problems, are benign.
Who is affected by endometriosis?
Endometriosis affects women in their reproductive years. The exact prevalence of endometriosis is not known, since many women may have the condition and have no symptoms. Endometriosis is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy in this country. While most cases of endometriosis are diagnosed in women aged around 25-35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis is more commonly found in white women as compared with African American and Asian women. Studies further suggest that endometriosis is most common in taller, thin women with a low body mass index (BMI). Delaying pregnancy until an older age is also believed to increase the risk of developing endometriosis.
What are endometriosis symptoms?
Most women who have endometriosis, in fact, do not have symptoms. Of those who do experience symptoms, the common symptoms are pain (usually pelvic) and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain or cramping with intercourse, bowel movements and/or urination. Even pelvic examination by a doctor can be painful. The pain intensity can change from month to month, and vary greatly among women. Some women experience progressive worsening of symptoms, while others can have resolution of pain without treatment.
Pelvic pain in women with endometriosis depends partly on where the implants of endometriosis are located.
•Deeper implants and implants in areas with many pain-sensing nerves may be more likely to produce pain.
•The implants may also produce substances that circulate in the bloodstream and cause pain.
•Lastly, pain can result when endometriosis implants form scars. There is no relationship between severity of pain and how widespread the endometriosis is (the "stage" of endometriosis).
Endometriosis can be one of the reasons for infertility in otherwise healthy couples. When laparoscopic examinations are performed for infertility evaluations, endometrial implants can be found in some of these patients, many of whom may not have painful symptoms of endometriosis. The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo.
Other symptoms related to endometriosis include:
•lower abdominal pain,
•diarrhea and/or constipation,
•low back pain,
•irregular or heavy menstrual bleeding, or
•blood in the urine.
Rare symptoms of endometriosis include chest pain or coughing blood due to endometriosis in the lungs and headache and/or seizures due to endometriosis in the brain.
Endometriosis and cancer risk
Women with endometriosis have a mildly increased risk for development of certain types of cancer of the ovary, known as epithelial ovarian cancer (EOC). This risk seems to be highest in women with endometriosis and primary infertility (those who have never borne a child), but the use of oral contraceptive pills (OCPs), which are sometimes used in the treatment of endometriosis, appears to significantly reduce this risk.
The reasons for the association between endometriosis and ovarian epithelial cancer are not clearly understood. One theory is that the endometriosis implants themselves undergo transformation to cancer. Another possibility is that the presence of endometriosis may be related to other genetic or environmental factors that also increase a women's risk of developing ovarian cancer.
How is endometriosis diagnosed?
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can be helpful in ruling out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but still cannot definitively diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
As a result, the only accurate way of diagnosing endometriosis is at the time of surgery, either by opening the belly with large-incision laparotomy or small-incision laparoscopy.
Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis. Laparoscopy is a minor surgical procedure done under general anesthesia, or in some cases under local anesthesia. It is usually performed as an out-patient procedure (the patient going home the same day). Laparoscopy is performed by first inflating the abdomen with carbon dioxide through a small incision in the navel. A long, thin viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.
During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed for a diagnosis. Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen during laparoscopy.
Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) that can cause symptoms that mimic endometriosis symptoms
How is endometriosis treated?
Before I give you treatment options, I have to tell you- there is no cure. Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.
If you think you may have this disease, please contact your doctor. God Bless!
Friday, March 12, 2010
Posted by Unknown at 1:22 AM


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A beautiful shot of Drosera Pallida flowers. Drosera Pallida is a fascinating climbing sundew. Like all sundews it is a carnivorous plant that lures it's prey in by sweet smelling leaves that are coated in a sticky secretion. However this particular species of Drosera uses its sticky pad-like leaves to climb higher in the foliage. Its flowers are held far above the bud-luring leaves to avoid pollinating insects becoming ensnared by the plant.
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The Labrador Retriever, also Labrador, is a type of retriever-gun dog. The Labrador is one of the most popular breeds of dog in the United Kingdom and the United States.
A favorite disability assistance breed in many countries, Labradors are frequently trained to aid the blind, those who have autism, to act as a therapy dog and perform screening and detection work for law enforcement and other official agencies. They are prized as sporting and hunting dogs.
The foundational breed of what is now the Labrador Retriever was known as the St. John's water dog, St. John's dog, or Lesser Newfoundland. When the dogs were later brought to England, they were named after the geographic area known as "the Labrador" (they were known as Labrador Retrievers because they "retrieved" in the Labrador Sea) or simply Labrador to distinguish them from the larger Newfoundland breed, even though the breed was from the more southern Avalon Peninsula.
The progenitors of the Labrador retriever were actually from Newfoundland and Labrador exceptionally, the breed known as the Newfoundland was created near the same time in Labrador. The two breeds' names and origins were mixed once moved into England and the Americas. The dog from Labrador became the large, long furred dog we see and know today, and the dog from Newfoundland became the Labrador.
In the early years of the breed through to the mid-20th century, Labradors of a shade we would now call "yellow" were in fact a dark, almost butterscotch, color (visible in early yellow Labrador photographs). The shade was known as "Golden" until required to be changed by the UK Kennel Club, on the grounds that "Gold" was not actually a color. Over the 20th century a preference for far lighter shades of yellow through to cream prevailed, until today most yellow Labradors are of this shade. Also fawn has been a common color in the yellow lab variety.
Interest in the darker shades of gold and fox red were re-established by English breeders in the 1980s, and three dogs were instrumental in this change: Balrion King Frost (black, born c. 1976) who consistently sired "very dark yellow" offspring and is credited as having "the biggest influence in the re-development of the fox red shade", and his great-grandson, the likewise famous Wynfaul Tabasco (b. 1986), described as "the father of the modern fox red Labrador", and the only modern fox red Show Champion in the UK. Other dogs, such as Red Alert and Scrimshaw Placido Flamingo, are also credited with passing on the genes into more than one renowned bloodline.
Jack Vanderwyk traces the origins of all Chocolate Labradors listed on the LabradorNet database (some 34,000 Labrador dogs of all shades) to eight original bloodlines. However, the shade was not seen as a distinct color until the 20th century; before then according to Vanderwyk, such dogs can be traced but were not registered. A degree of crossbreeding with Flatcoat or Chesapeake Bay retrievers was also documented in the early 20th century, prior to recognition. Chocolate Labradors were also well established in the early 20th century at the kennels of the Earl of Feversham, and Lady Ward of Chiltonfoliat.
The bloodlines as traced by Vanderwyk each lead back to three black Labradors in the 1880s—Buccleuch Avon (m), and his sire and dam, Malmesbury Tramp (m), and Malmesbury June (f). Morningtown Tobla is also named as an important intermediary, and according to the studbook of Buccleuch Kennels, the chocolates in this kennel came through FTW Peter of Faskally (1908).
Labradors are medium-large, with males typically weighing 65–80 lb (29–36 kg) and females 55–71 lb (25–32 kg). Labradors weighing close to or over 100 lb (45 kg) are considered obese or having a major fault under American Kennel Club standards, although some Labradors weigh significantly more. The majority of the characteristics of this breed, with the exception of colour, are the result of breeding to produce a working retriever.
As with some other breeds, the Conformation (typically "Show", "English" or "bench") and the Field (typically "Working" or "American") lines differ, although both lines are bred in both countries. In general, however, Conformation Labradors tend to be bred as medium-sized dogs, shorter and stockier with fuller faces and a slightly calmer nature than their Field counterparts, which are often bred as taller, lighter-framed dogs, with slightly less broad faces and a slightly longer nose. However, Field Labradors should still be proportional and fit within American Kennel Club standards. With Field Labradors, excessively long noses, thin heads, long legs, and lanky frames are not considered standard. These two types are informal and not codified or standardised; no distinction is made by the AKC or other kennel clubs, but the two types come from different breeding lines. Australian stock also exists; though not seen in the West, they are common in Asia. These dogs are also very good with children.
The breed tends to shed hair twice annually or regularly throughout the year in temperate climates. Some Labradors shed considerably; however, individual Labradors vary. Labrador hair is usually short and straight, and the tail is quite broad and strong. The webbed toes of the Labrador Retriever make them excellent swimmers. The webbing between their toes can also serve as a "snowshoe" in colder climates and keep snow from balling up between their toes—a condition that can be painful to other breeds with hair between the toes. Their interwoven coat is also relatively waterproof, providing more assistance for swimming.
Official breed standards
There is a great deal of variety among Labradors. The following characteristics are typical of the conformation show bred (bench-bred) lines of this breed in the United States and are based on the American Kennel Club standard. Significant differences between UK and US standards are noted.
- Size: Labradors are a medium-large breed. They should be as long from the withers to the base of the tail as they are from the floor to the withers. Males should stand 22–24 inches (56–61 cm) tall at the withers and weight 65–80 lb (29–36 kg). Females should stand 22–23 inches (56–58 cm) and weigh 55–71 lb (25–32 kg). By comparison under UK Kennel Club standards, height should be 22–24 inches (56–61 cm) for males, and 22–23 inches (56–58 cm) for females.
- Coat: The Labrador Retriever's coat should be short and dense, but not wiry. The coat is water-resistant, so the dog does not get cold when taking to water in the winter. That means that the dog naturally has a slightly dry, oily coat. Acceptable colours are black, yellow, and chocolate.
- Head: The head should be broad with slightly pronounced eyebrows. The eyes should be kind and expressive. Appropriate eye colours are brown and hazel. The lining around the eyes should be black. The ears should hang close to the head and set slightly above the eyes.
- Jaws: The jaws should be strong and powerful. The muzzle should be of medium length and should not be too tapered. The jaws should hang slightly and curve gracefully back.
- Body: The body should have a powerful and muscular build.
The tail and coat are designated "distinctive [or distinguishing] features" of the Labrador by both the Kennel Club and AKC. The AKC adds that "true Labrador Retriever temperament is as much a hallmark of the breed as the 'otter' tail."
Labrador Retrievers are registered in three colors: black (a solid black colour), yellow (considered from cream to fox-red), and chocolate (medium to dark brown). Some dogs are sold as silver pure-bred Labradors, but purity of those bloodlines is currently disputed by breed experts including breed clubs and breed councils. Some major kennel clubs around the world allow silver Labradors to be registered, but not as silver. The Kennel Club (England) requires that they be registered as "Non-recognized.” Occasionally, Labradors will exhibit small amounts of white fur on their chest, paws, or tail, and rarely a purebred Lab will exhibit brindling stripes or tan points similar to a Rottweiler. These markings are a disqualification for show dogs but do not have any bearing on the dog's temperament or ability to be a good working or pet dog.
Puppies of all colours can potentially occur in the same litter. Color is determined primarily by three genes. The first gene (the B locus) determines the density of the coat's eumelanin pigment granules, if that pigment is allowed: dense granules result in a black coat, sparse ones give a chocolate coat. The second (E) locus determines whether the eumelanin is produced at all. A dog with the recessive e allele will produce only phaeomelanin pigment and will be yellow regardless of its genotype at the B locus. The genes known about previously have had their number increased by the introduction of the K locus, where the dominant "black" allele KB is now known to reside. Black or chocolate Labradors therefore must have the KB allele. Yellow Labradors are determined at the E locus, so the K locus is irrelevant in determining their colour. Variations in numerous other genes control the subtler details of the coat's colouration, which in yellow Labradors varies from white to light gold to a fox red. Chocolate and black Labradors' noses will match the coat colour.
According to a 2011 study, 13 out of 245 Labradors studied were heterozygous for the M264V mutation responsible for the melanistic mask, and one was homozygous. Within the breed, this trait is not visible.
Nose and skin pigmentation
Labrador coloration is controlled by multiple genes. It is possible for recessive genes to re-emerge in later generations. Also, there can sometimes be unexpected pigmentation effects to different parts of the body. Pigmentation effects appear in regard to yellow Labradors, and sometimes chocolate, and hence the majority of this section covers pigmentation within the yellow Labrador. The most common places where pigmentation is visible are the nose, lips, gums, feet, tail, and the rims of the eyes, which may be black, brown, light yellow-brown ("liver", caused by having two genes for chocolate), or several other colors. A Labrador can carry genes for a different colour, for example a black Labrador can carry recessive chocolate and yellow genes, and a yellow Labrador can carry recessive genes for the other two colours. DNA testing can reveal some aspects of these. Less common pigmentations (other than pink) are a fault, not a disqualification, and hence such dogs are still permitted to be shown.
The intensity of black pigment on yellow Labradors is controlled by a separate gene independent of the fur colouring. Yellow Labradors usually have black noses, which may gradually turn pink with age (called "snow nose" or "winter nose"). This is due to a reduction in the enzyme tyrosinase which indirectly controls the production of melanin, a dark colouring. Tyrosinase is temperature dependent—hence light coloration can be seasonal, due to cold weather—and is less produced with increasing age two years old onwards. As a result, the nose color of most yellow Labradors becomes a somewhat pink shade as they grow older.
A coloration known as "Dudley" is also possible. Dudleys are variously defined as yellow Labradors which have unpigmented (pink) noses (LRC), yellow with liver/chocolate pigmentation (AKC), or "flesh coloured" in addition to having the same colour around the rims of the eye, rather than having black or dark brown pigmentation. A yellow Labrador with brown or chocolate pigmentation, for example, a brown or chocolate nose, is not necessarily a Dudley, though according to the AKC's current standard it would be if it has chocolate rims around the eyes (or more accurately of the genotype eebb). Breed standards for Labradors considers a true Dudley to be a disqualifying feature in a conformation show Lab, such as one with a thoroughly pink nose or one lacking in any pigment along with flesh coloured rims around the eyes. True Dudleys are extremely rare. Breeding in order to correct pigmentation often lacks dependability. Because colour is determined by many genes, some of which are recessive, crossbreeding a pigmentation non-standard yellow Labrador to a black Labrador may not correct the matter or prevent future generations carrying the same recessive genes. For similar reasons, crossbreeding chocolate to yellow Labradors is also often avoided.
Show and field lines
Head and muzzle appearance: field (left), and show (right), showing the shorter muzzle length, more solid appearance head, and "pronounced" stop of the latter.
The field Labradors have lighter and slightly narrower heads with longer muzzles.
As a result of specialised breeding there are significant differences between field and trial-bred and show-bred lines of Labradors. In the United States the former are sometimes mistakenly referred to as "American" and the latter as "English" although both field and show types are bred in both countries. In the United Kingdom they are called "Field" and "Show". Dogs bred for hunting and field-trial work are selected first for working ability, where dogs bred to compete in conformation shows are selected for their conformation to the standards and characteristics sought by judges in the show ring.
While individual dogs may vary, in general show-bred Labradors are heavier built, slightly shorter-bodied, and have a thicker coat and tail. Field Labradors are generally longer legged, lighter, and more lithe in build, making them agile. In the head, show Labradors tend to have broader heads, better defined stops, and more powerful necks, while field Labradors have lighter and slightly narrower heads with longer muzzles. Field-bred Labradors are commonly higher energy and more high-strung compared to the Labrador bred for conformation showing while conformation breeds are calmer in energy, and as a consequence may be more suited to working relationships than being a "family pet". Some breeders, especially those specialising in the field type, feel that breed shows do not adequately recognise their type of dog, leading to occasional debate regarding officially splitting the breed into subtypes.
In the United States, the American Kennel Club(AKC) and the Labrador's breed club have set the breed standard to accommodate the field-bred Labrador somewhat. For instance, the AKC withers-height standards allow conformation dogs to be slightly taller than the equivalent British standard. However, dual champions, or dogs that excel in both the field and the show ring, are becoming more unusual.
Labradors have a reputation as a very even-tempered breed and an excellent family dog. This includes a good reputation with children of all ages and other animals. Some lines, particularly those that have continued to be bred specifically for their skills at working in the field (rather than for their appearance), are particularly fast and athletic. Their fun-loving boisterousness and lack of fear may require training and firm handling at times to ensure it does not get out of hand—an uncontrolled adult can be quite problematic. Females may be slightly more independent than males. Labradors mature at around three years of age; before this time they can have a significant degree of puppy-like energy, often mislabelled as being hyperactive. Because of their enthusiasm, leash-training early on is suggested to prevent pulling when full-grown. Labradors often enjoy retrieving a ball endlessly (often obsessively) and other forms of activity (such as agility, frisbee, or flyball).
Although they will sometimes bark at noise, especially noise from an unseen source ("alarm barking"), Labradors are usually not noisy or territorial. They are often very easygoing and trusting with strangers and therefore are not usually suitable as guard dogs.
Labradors have a well-known reputation for appetite, and some individuals may be highly indiscriminate, eating digestible and non-food objects alike. They are persistent and persuasive in requesting food. For this reason, the Labrador owner must carefully control their dog's food intake to avoid obesity and its associated health problems (see below).
The steady temperament of Labradors and their ability to learn make them an ideal breed for search and rescue, detection, and therapy work. They are a very intelligent breed. The AKC describes the breed as an ideal family and sporting dog. Their primary working role in the field continues to be that of a hunting retriever.
Labrador pups generally are not brought to the home before they are 8 weeks old. Their life expectancy is generally 10 to 12 years, and it is a healthy breed with relatively few major problems. Notable issues related to health and well-being include:
Labradors are somewhat prone to hip and elbow dysplasia, especially the larger dogs,though not as much as some other breeds.
Hip scores are recommended before breeding and often joint supplements are recommended.
Labradors also suffer from the risk of knee problems. A luxating patella is a common occurrence in the knee where the knee dislocates and goes back into place.
Eye problems are also possible in some Labradors, particularly progressive retinal atrophy, cataracts, corneal dystrophy and retinal dysplasia. Dogs which are intended to be bred should be examined by a veterinary ophthalmologist for an eye score.
Hereditary myopathy, a rare inherited disorder that causes a deficiency in type II muscle fibre. Symptoms include a short stilted gait or "bunny hopping," and in rare cases ventroflexion of the neck accompanied by a kyphotic posture.
There is a small incidence of other conditions, such as autoimmune diseases and deafness in Labradors, either congenitally or later in life.
Labradors often suffer from exercise induced collapse, a syndrome that causes hyperthermia, weakness, collapse, and disorientation after short bouts of exercise.
Out of all dog breeds it is the Labrador Retriever that is most likely to obese. This obesity has been attributed to a specific gene mutation. See the Obesity sub section below.
Labradors like to eat, and without proper exercise can become obese. Laziness is a contribution to this. Obesity is a serious condition and can be considered the number one nutritional problem with dogs. A study shows that at least 25% of dogs in the United States are overweight. Therefore, Labradors must be properly exercised and stimulated. A healthy Labrador can do swimming wind sprints for two hours, and should keep a very slight hourglass waist and be fit and light, rather than fat or heavy-set. Obesity can exacerbate conditions such as hip dysplasia and joint problems, and can lead to secondary diseases, including diabetes. Osteoarthritis is very uncommon in older, especially overweight, Labradors. A 14-year study covering 48 dogs by food manufacturer Purina showed that Labradors fed to maintain a lean body shape outlived those fed freely by around two years, emphasising the importance of not over-feeding. Labradors should be walked twice a day for at least half an hour.
It has been shown that out of all dog breeds, it is the Labrador Retriever that is most likely to obese. In a 2016 published study it was shown that out of 310 Labradors, most were missing all or parts of the POMC gene. This gene plays a part in appetite regulation as well as indication of the amount of one's stored fat. The study concluded that the absence of that gene had a significant impact on Labrador weight and appetite. The POMC gene mutation is present in only one other breed - the Flat-coated Retriever.
Yellow Labrador Retriever
|Origin||United Kingdom & Canada|
|Foundation stock||St. John's water dog|
|Notes||Provincial mammal of Labrador|


Ancestry DNA Testing
Ancestry DNA Testing, How is it conducted?Ancestry DNA testing is very simple and easy. A DNA kit is sent to you. You take out a swab and gently scrape the inside of your cheeks, put scraping in provided vial, put vial in return packaging and send package back to lab. You will then get your results back in 3 to 4 weeks.
Types of Ancestry DNA testingThere are three types of genealogical DNA tests, autosomal (atDNA), mitochondrial DNA (mtDNA), and Y-Chromosome (Y-DNA). Autosomal tests for all ancestry. Y-DNA tests a male along his direct paternal line. mtDNA tests a man or woman along their direct maternal line. We will focus on two types of Ancestry DNA testing, Paternal DNA Testing (yDNA) and Maternal DNA testing (mtDNA). The mother passes on mitochondria (mtDNA) to her children, sons and daughters, while the father passes the yDNA only to his sons. A male can be tested for both paternal yDNA and Mitochondria (mtDNA) DNA test, while the female can only be tested for the Maternal, Mitochondria test (mtDNA). So from a family point of view, if the Father and Mother take the appropriate DNA test, their results can be used for the whole family. If the Father or Mother DNA is not available to take the appropriate test, then the daughter or son of the family could provide all of the necessary information to do DNA genetic research for the family. Likewise, a brother or sister of the family can share their information with the rest of the family. With Family DNA Roots you can have your Ancestry DNA testing performed for your whole family at one low price by purchasing the Family Ancestry DNA test kit.
Autosomal DNA: 22 chromosome pairs
- Each parent passes on a random half of their 22 pairs
- (1 copy of each) to each offspring.
- Each offspring will have different set of half. Part of ‘Nuclear’ DNA
Gender DNA: X and Y pair together
Sex chromosomes, part of ‘Nuclear’ DNA
- Males are determined by the fact that they have and “X” and a “Y”
- Females are determined by the fact that they have 2 “X” (“XX”) and no “Y”
- Just like the autosomal DNA, each parent give a random half of one of these
- to each offspring. The mother can only pass on an “X”, but the father either
- passes on the “X” OR the “Y”. The “X” means child will be female and “Y” male.
- Male sons will pass the same “Y” copy onto their sons, and so on.
- The Y chromosome is small, does not really mix with the X and thus does not experience frequent mutations.
Mitochondrial DNA (mtDNA): Independent
- Human cells have organelles called mitochondrion that produce energy.
- These organelles have their own DNA independent of rest of Nuclear DNA.
- Female ‘eggs’ contain all the cellular material needed, including mitochondrion.
- Sperm contain ONLY DNA, no mitochondrion.
- So mtDNA gets passed ONLY from mother to daughter or son.
- Daughters will in turn pass it on to children, sons will not.
- mtDNA is small, does not mix with anything, has a lot information on in, and So does not experience frequent mutations.
A designation used to describe ancestral history of Y chromosome and mtDNA. Each letter and location represents where human migration/settlements and corresponding DNA mutations are estimated to have occurred thousands of years ago.
What do you receive with your Family DNA Testing results?When you receive your kit, you will receive access to your DNA information through a website provided by Family DNA Roots, a certificate displaying your haplogroup, and a certificate displaying your World Wide Ancestry composition. On the website, you will be provided with information about your yDNA and mtDNA haplogroups. A haplogroup is a classification of where you are mapped in the human tree. It looks similar to a tree with the tree trunk being the base and the branches spanning out from the base of the tree. There are haplogroup classifications for both the Maternal and Paternal designations. The haplogroup are labeled using a combination of letters and numbers. For the paternal the 'A' haplogroup is at the root and for the Maternal the 'L0' halopgroup is at the root. The root haplogroups are classified as Scientific Adam and Scientific Eve. Everyone can trace their roots to these two haplogroup types.
For a summary of all the services offered by Family DNA Roots, click here


The elimination of all plant pests / diseases is not practical given the numerous environmental challenges trees and shrubs face in the urban landscapes we create. At best, controlling insect or disease outbreaks can be accomplished once the problem(s) have been properly identified and a program of actions are undertaken.
PLANT DISEASE DAMAGE SIGNS
Many plant diseases are caused by fungi that are fairly specific to a narrow group of plants. Disease damage signs can appear as spotting of leaves, a coating or film over the foliage or branch dieback.
IPM programs target specific plants with properly identified challenges. In most cases involving foliar disease, a series of foliage protectant applications applied in the spring through early summer is recommended.
Retaining the leaves on the trees through the growing season allows the plants to reach their full growth potential. Repeated tree canopy defoliation due to foliar disease damage encourages rapid tree decline.
Common Diseases that May Occur in the Chicagoland area
INSECT DAMAGE SIGNS
Plant damaging insects have fairly predictable damage cycles that are fairly specific to tree species and time frames. Populations of these damaging pests will vary in severity each year depending on factors influencing their development. Feeding insect damage can vary widely in appearance from holes in the leaves, edges being notched, feeding between veins to entire leaves being removed. The type of damage is used as one of the identifying characteristics to determine the species. In many cases the insect will not appear during the daylight hours to feed or it may hide in the adjacent foliage making identification a challenge.
Proper identification of the insect species, life cycle stage and damage are necessary to determine the appropriate control options. In many cases the identified pest doesn't produce a significant amount of damage and control measures are unnecessary.
Determination of treatment would be completed by one of our Certified Arborists. Treatment methods recommended are always aimed at supporting best practices for overall tree health.
Common insect pests that May Occur in the Chicagoland area
300 Charles Court
West Chicago, Illinois 60185
Monday – Friday 8am – 4 pm
Saturday – Closed


The reproductive benefits and health costs of androgens are well studied in males, but underappreciated in females, despite substantial variation in female androgen production. In the cooperatively breeding meerkat (Suricata suricatta), raised androgens may improve the competitive abilities of dominant females, ensuring their near-exclusive control over reproduction. If, as in the males of some species, female meerkats suffer from androgen-mediated immunosuppression, rank-related differences in androgens could produce rank-related effects on immunocompetence. Previously, we showed that (a) dominant females were the most heavily parasitized group members (Smyth & Drea, 2015), (b) within females, parasitism correlated with fecal androgen concentrations (Smyth et al. in prep), and (c) dominant females routinely have higher concentrations of sex steroids (androstenedione, testosterone, and estradiol) than do subordinates (Davies et al. 2016). Here, in 95 wild meerkats, we evaluated associations between constitutive immunity (bacteria killing ability and hemolytic-complement activity) and sex-steroid concentrations. Males, that show no rank-related differences in sex-steroid concentrations, also showed no rank-related differences in immunocompetence. Compared to subordinate females, however, dominant females were immunocompromised. Because both androstenedione and testosterone, but not estradiol, were strong predictors of constitutive immunity in females, androgens may mediate the health disparity in this female-dominant species. Supported by NSF IOS-1021633.


Do You Know The Early Signs Of Heart Disease?
Being diagnosed with familial hypercholesterolemia may be distressing, but the earlier it is caught, the earlier treatment can begin in order to prevent further cardiovascular damage. Unfortunately, many individuals who have FH miss the early signs of heart disease because they don’t recognize the earliest symptoms or they mistake them for the symptoms of other, less serious illnesses, often disregarding family history of heart disease. The common misconception that only older adults can have cardiovascular disease is also an issue.
Don’t Miss the Early Signs of Heart Disease
There is a common misconception that minor pain or pain in various parts of the body does not indicate a heart problem. Some people are surprised to discover that not all heart attacks involve massive pain or a collapse that results in the need for an ambulance. In fact, some indicators are so insignificant that people overlook or dismiss them. If you have any of the symptoms below, you should see your doctor and ask him if they could be early signs of heart disease
This painful condition is sometimes the precursor to cardiac arrest, although it can also recur for years without triggering any more serious signs. Angina is the most common early warning of cardiovascular disease and can manifest itself in a variety of ways, including a feeling of heaviness in the chest, pain, a squeezing sensation, weight on the chest or a deep pain that causes you to catch your breath. Many people mistake angina for heartburn or indigestion, particularly since the pain is sometimes felt in other areas of the body, including pain in the shoulder, the middle or upper region of the back or even the jaw line.
More Early Signs of Heart Disease
There are other indications of heart disease that may come and go for months or even years without an individual connecting them with any sort of serious problem such as cardiovascular illness. Among these are dizziness, shortness of breath after exertion or exercise, sweating, a rapid pulse and heart palpitations. Many people dismiss these signs if they are under fifty years of age, particularly if the symptoms come and go.
A Family History of Early Heart Disease or Heart Attacks
If there are other close relatives in your family who are contending with heart disease in any form, it could be a sign of genetic familial hypercholesterolemia. If a parent, sibling or child has been coping with cardiovascular health problems, they and the rest of the family should be tested for FH.
The Silent Signs of Heart Disease
For some people, the early signs of heart disease aren’t felt or heard, but are discovered as the result of testing of some kind. High cholesterol is one such symptom that can eventually lead to more serious, painful conditions after years of being a silent time bomb. Many health care organizations now recommend that if any man younger than 55 or any woman younger than 65 is diagnosed with heart disease, their immediate family members should be tested for high cholesterol and familial hypercholesterolemia because of the risk associated with a family history of heart disease..


Norfolk Wildlife Trust - Event
Monday 25 March
7.30 to 9pm
Southrepps Village Hall, Chapel Street, Southrepps, Norfolk, NR11 8NW
Common (and not so common) Wildlife
From barn owls to turtle doves, hedgehogs to watervoles this illustrated talk by Gemma Walker (Norfolk Wildlife Trust, Wildlife and Community Officer) will introduce you to some common (and not so common) species associated with Norfolk commons. Discover the natural and unnatural history of some of the species found on Norfolk commons and learn about the new Wildlife in Common project funded by the Heritage Lottery.
This talk is free, no need to book.


Vaccine strategy modelling
In a major collaboration with Prof. Colin R Simpson (Victoria University of Wellington), and leading scientists and academics, ESR provides an interactive dashboard which seeks to forecast the outcomes of a range of possible models for New Zealand's COVID-19 response.
The publicly available dashboard, which is available here(external link) considered over 400,000 possible scenarios and provides the user with the ability to change various inputs such as maximum vaccination uptake per age group, minimum age for vaccination and vaccine effectiveness for disease prevention. The dashboard accopanies the study COVID-19 vaccine strategies for Aotearoa New Zealand: a mathematical modelling.(external link)
ESR was the first in New Zealand to sequence the genetic material of SARS CoV-2 from patients (external link)and since then it has become a key tool in our fight against COVID-19.
ESR are able to accept samples for urgent and routine sequencing in Auckland, Wellington, and our Christchurch facility is also able to accept samples for urgent sequencing. For a Q & A on genome sequencing - click here
We are undertaking novel research into the testing of wastewater(external link) for the presence of SARS CoV-2. The overall goal long-term is for robust and reliable tools for the detection of SARS-CoV-2 in sewage, that can be used to identify any unrecognised COVID-19 infections in New Zealand. We also want to gauge how infectious it is in sewage and the persistence of SARS-CoV-2 in sewage.
ESR has a research project exploring whether individuals could give a saliva sample to be tested for SARS-CoV-2. This includes the Air NZ study. This is based on overseas work that suggests that there may be a role for a test that is more comfortable for people, that could therefore be used more frequently. A nasopharyngeal sample is currently the best practice tool for diagnosis, and this is unlikely to change with the introduction of saliva as a sample, but ESR is looking at whether saliva samples could be used in certain settings as a screening tool.
Flu research ties in COVID-19
We have extended our long-established flu research to include COVID-19(external link). Two large-scale and long-term studies, SHIVERS-II and WellKiwis, have expanded to include testing for SARS-CoV-2, the virus that causes COVID-19.
We are collaborating with other organisations to research how we can use novel data sources and machine learning(external link) to predict further outbreaks of COVID-19.
Serology tests (antibody tests)
Regarding serology tests (where we look for antibodies from a previous COVID-19 infection), these are becoming more important as the pandemic progresses and we look to find those people who have had the disease but didn’t know they were ill. There are many such tests and understanding the value of various test options will be important in knowing how they can best be applied. ESR has been evaluating several tests. Additionally, we are awaiting ethics around a study in the serology area so keep your eyes peeled for this.
Potential for foodborne transmission of COVID-19
ESR has contributed to The New Zealand Food Safety Science & Research Centre (NZFSSRC) reports into the potential for foodborne transmission of SARS-CoV-2, and address industry questions around guidance on management practices. The latest (5th) version of the report(external link) was on Dec 15 2020 and uploaded on 14 Jan.
Exploring opportunities for sewage testing on ships as a tool to screen seafarers for COVID-19
New Zealand’s strategy to eliminate COVID-19 from the community carries an explicit requirement to identify and isolate all cases of COVID-19 arriving at the border to prevent incursions into the community. Under the Maritime Border Order (No. 2) 2020, arriving maritime crew may apply to disembark their vessel where all crew members have completed a 14-day isolation/quarantine, have returned a negative nasopharyngeal test, and are free from symptoms of COVID-19. This report [PDF, 1 MB] explores the potential application of sewage testing on ships arriving at the maritime border, as part of New Zealand’s border control processes.


A root canal treatment is used to save a tooth which otherwise needs to be removed.
A root canal treatment is necessary when the blood or nerve supply of the tooth (pulp) is infected through decay or injury. In the early stages of the infection you may not experience any pain, but once the pulp becomes infected, the infection may spread through the root canal system of the tooth. This may eventually lead to an abscess which is characterized by an inflamed area in which pus gathers and can cause swelling of the area around the tooth. The symptoms of an abscess can range from a dull ache to severe pain, and the tooth may be quite tender when you bite. If root canal treatment is not done, the infection will eventually spread, and the tooth may need to be removed.
The objective of the treatment is to disinfect the root canal(s). The root canal system is then cleaned and filled to prevent any further infection.
Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to us. At the first appointment, the infected pulp is cleared, and the infection can be drained. The root canal is then cleaned and shaped ready for the filling. A temporary filling is put in and the tooth is left to settle.
The tooth is checked at a later visit and when all the infection has cleared, the canals are obturated and the tooth permanently filled.
Also, please note that there are certain cases that if we feel that there may be a complication with your treatment, we may refer you to an endodontist, who is a specialist in particularly complex root canals.


If you ever think of something flying in a similar way as fish glides in the water, here it is. Made at Empa in collaboration with aeroix GmbH and the Technical University of Berlin, this is the world’s first EAP propelled airship. This fish shaped vehicle is lighter than air and is eight meter in length.
The airship has a lightly pressurized helium filled body, which is biologically inspired with Dielectric Elastomer (DE) actuators. DEs act as biological muscles and deforming the body and tail fin in a fish like manner.
The actuators on the ship work in an agonist-antagonist configuration. Also, the air ship’s fish like movement is supported by actuators on the either side – if one is activated the parallel one contracts.
EAPs are activated with frequency, activation voltage and a phase shift between the body and the tail fin movement and the flight is controlled with a joy stick which is connected to a ground-based portable computer.
The electric supply and the control system for the airship were developed at Empa and everything was optimized to keep the weight minimum. Also, the skeleton and other parts that include an ultra-light carbon-sandwich structure and a model-airship hull material were developed by the aeroix GmbH in Berlin.


Immunization shots, or vaccinations, are essential.
They protect you from a disease by introducing a tiny, weakened piece of the germ into your body. Your body then produces the things it needs to combat it. This is called building an immunity. That way, if you are ever exposed naturally to the disease, your body “remembers” the germ and is ready to fight it.
Vaccinations protect you against diseases like measles, mumps, rubella, hepatitis B, and polio. They are important for both adults and children because unlike most medicines which treat or cure a disease, vaccines can prevent them.
The vaccinations you need depend on your age, lifestyle, healthy, pregnancy status, and travel plans. Talk to your doctor about what shots you and your children need and when you should get them. For additional information, refer to the CDC’s immunization schedules for children (birth to 18 years old) and adults (19 years and older).
Vivida Health Plan Members have access to vaccinations at no cost. Learn more about how to join.
Current members, call Member Services at 844-243-5131 (TTY: 711) to learn more about your vaccination benefits. Find a doctor to talk about the vaccinations you and your children need to stay healthy.


- Provides comprehensive nutritional support, with therapeutic dosages, for diverse factors affecting reproductive health
- Broad-spectrum antioxidants reduce oxidative stress and damage, and enhance mitochondrial function, key determinants of oocyte function and quality
- Provides the most bioavailable forms of nutrients, including pyridoxal 5’-phosphate, d-alpha tocopheryl, vitamin D3, methylcobalamin, and (6S)-5-methyltetrahydrofolic acid
- Supports proper endometrial blood flow, supplying nutrients, removing toxins and reactive oxygen species (ROS) from the endometrium, and encouraging proper implantation
Opti Ova is a comprehensive female reproductive support kit that provides an effective combination of key antioxidants, omega-3 fatty acids, vitamins, and minerals shown to improve egg quality and enhance fertility. By optimizing mitochondrial function, reducing oxidative stress, supporting blood flow to the endometrium and its development, and enhancing detoxification pathways, Opti Ova provides a broad base of nutritional support for reproductive health.
Mitochondrial activity is a key factor in oocyte function and quality, with mitochondrial dysfunction recognized as a major cause of age-induced decline in oocyte quality.1,2 Key nutrients, including PQQ, resveratrol, and CoQ10, have been shown to induce mitochondrial biogenesis,3counteract ovarian aging,4,5 and when combined with clomiphene citrate, CoQ10 supplementation resulted in a more than 6-fold increase in the clinical pregnancy rate than clomiphene alone, in a randomized prospective trial of participants with PCOS.6
N-acetylcysteine provides the limiting factor for glutathione production, essential for detoxification of many pollutants which interfere with reproductive function; it has also been shown to improve pregnancy rates and endometrial thickness when compared to standard treatments for PCOS, such as clomiphene and metformin.7
L-carnitine, Japanese knotweed, and magnesium also benefit women with PCOS.8
Opti Ova includes vitamins D and E, omega-3 fatty acids, key minerals, and bioavailable B vitamins which act as potent antioxidants and support optimal endometrial health and implantation.9-12 Vitamin E supplementation alone has been shown to shorten the time to pregnancy among women older than 35 seeking treatment for unexplained infertility, while vitamin D has been linked to implantation rates and IVF outcomes, with the highest levels linked to the highest pregnancy rates.13-16
|Each Softgel Contains:|
|Coenzyme Q10 (Microorganism) (whole cell)||200 mg|
|BioPQQ® Pyrroloquinoline Quinone (Disodium Salt)||17.65 mg|
|SUN-E 900™ Vitamin E (d-Alpha Tocopherol) (Helianthus annuus) (seed)||5 IU (3.35 mg AT*)|
|Non-medicinal Ingredients: Softgel (gelatin, glycerin, purified water, carob powder), organic flaxseed oil, yellow beeswax, non-GMO sunflower oil, lecithin.|
|N-Acetyl-L-Cysteine and Alpha-Lipoic Acid|
|Each Tablet Contains:|
|NAC (N-Acetyl-L-Cysteine)||250 mg|
|Alpha-Lipoic Acid||300 mg|
|Non-medicinal Ingredients: Microcrystalline cellulose, dibasic calcium phosphate dihydrate, stearic acid, vegetable grade magnesium stearate (lubricant), clear coating (carbohydrate gum [cellulose], glycerin), silica, croscarmellose sodium.|
|Each Capsule Contains:|
|Vitamin B1 (Thiamine Hydrochloride, Benfotiamine)||31.7 mg|
|Vitamin B2 (Riboflavin 5’-Phosphate Sodium)||10 mg|
|Niacin (Inositol Hexanicotinate)||100 mg|
|Vitamin B5 (Calcium d-Pantothenate)||100 mg|
|Vitamin B6 (Pyridoxal 5’-Phosphate Monohydrate)||25 mg|
|Vitamin B12 (Methylcobalamin)||500 mcg|
|Folate (from (6S)-5-Methyltetrahydrofolic Acid (MTHF), Glucosamine Salt, Quatrefolic®)||400 mcg|
|Choline Dihydrogen Citrate||50 mg|
|Inositol (Inositol Hexanicotinate)||50 mg|
|Non-medicinal Ingredients: Vegetarian capsule (carbohydrate gum [cellulose], purified water), microcrystalline cellulose, vegetable grade magnesium stearate (lubricant), silica, organic kale, organic alfalfa, organic cilantro leaf, organic parsley, caperberry, sprouted garlic, organic artichoke, organic black radish, organic dandelion, barley grass, pepper, organic celery seed, organic beetroot, organic tomato, wasabi rhizome, fresh freeze-dried sprouted broccoli, organic upland cress, daikon, red radish, organic cauliflower, organic cabbage, organic arugula, organic watercress leaf, grape, pomegranate, strawberry, organic cranberry, organic blueberry, raspberry, bilberry, organic Indian gooseberry, schizandra berry, red orange, organic açai berry, Theracurmin® curcumin, organic decaffeinated green tea extract, organic ginger rhizome, organic echinacea, organic oregano, organic peppermint, organic spearmint, organic spirulina, organic chlorella, red algae, blue green algae, kelp.|
|Each Capsule Contains:|
|L-Carnitine (Tartrate)||500 mg|
|Non-medicinal Ingredients: Vegetarian capsule (carbohydrate gum [cellulose], purified water), silica, microcrystalline cellulose, vegetable grade magnesium stearate (lubricant).|
|Resveratrol with Grape Seed Extract|
|Each Capsule Contains:|
|Japanese Knotweed Extract (Fallopia japonica) (root) (20% Trans-Resveratrol)||200 mg|
|Grape Seed Extract (Vitis vinifera) (seed) (80% Oligomeric Proanthocyanidins)||25 mg|
|Non-medicinal Ingredients: Gelatin capsule (gelatin, purified water), microcrystalline cellulose, vegetable grade magnesium stearate (lubricant), silica.|
|Vitamin E 400 with Selenium|
|Each Tablet Contains:|
|Vitamin E (d-Alpha Tocopheryl Acid Succinate)||400 IU (268 mg AT*)|
|Selenium (Yeast)||100 mcg|
|Vitamin C (Ascorbic Acid)||100 mg|
|Manganese (Gluconate)||10 mg|
|Non-medicinal Ingredients: Dibasic calcium phosphate dihydrate, microcrystalline cellulose, silica, croscarmellose sodium, vegetable grade magnesium stearate (lubricant), coating (carbohydrate gum [cellulose], glycerin).|
|Each Capsule Contains:|
|Magnesium (Bisglycinate)||200 mg|
|Non-medicinal Ingredients: Vegetarian capsule (carbohydrate gum [cellulose], purified water), microcrystalline cellulose, vegetable grade magnesium stearate (lubricant), silica.|
|OptiMega3® with Vitamin D3|
|Each Enteripure® Softgel Contains:|
|Fish Oil Concentrate (Anchovy, Sardine, and/or Mackerel)||1425 mg|
|Omega-3 Fatty Acids||900 mg|
|Eicosapentaenoic Acid (EPA)||600 mg|
|Docosahexaenoic Acid (DHA)||300 mg|
|Vitamin D3 (Cholecalciferol)||1000 IU (25 mcg)|
|Non-medicinal Ingredients: Enteric softgel (gelatin, glycerin, purified water, pectin), natural vitamin E.|
Contains no artificial colours, preservatives, or sweeteners;
no dairy, starch, sugar, wheat, gluten, yeast, soy, corn, egg,
fish, shellfish, animal products, salt, tree nuts, or GMOs.
Suitable for vegetarians/vegans.
Recommended Adult Dose: 1 packet per day with food or as directed by a health care practitioner. Source of
Antioxidants: Consult a health care practitioner for use beyond 3 months.
Keep out of reach of children.
Mixed Vitamin E 400 IU
Consult a health care practitioner prior to use if you have cancer, cardiovascular disease, diabetes, or are taking blood thinners.
Do not use if you are pregnant or breastfeeding. Consult a health care practitioner prior to use if you are taking medications for diabetes, high blood pressure, seizures, or if you have diabetes, a seizure disorder, liver or kidney disease, or have been instructed to follow a low protein diet. Do not use if you are taking health products with a blood coagulation affect (e.g., blood thinners, clotting factor replacements, acetylsalicylic acid, ibuprofen, fish oils, vitamin E) as this may increase the risk of spontaneous bleeding.
Consult a health care practitioner prior to use if you are pregnant or breastfeeding, or are taking blood pressure medication or blood thinners.
Consult a health care practitioner prior to use if you are pregnant or breastfeeding, or if you have diabetes or kidney stones. Do not use this product if you are taking antibiotics or nitroglycerin.
People sensitive to nicotinic acid may experience flushing of the skin that is generally mild and transient.
1. Schatten, H., Sun, Q.Y., Prather, R. (2014). The impact of mitochondrial function/dysfunction on IVF and new treatment possibilities for infertility. Reprod Biol Endocrinol, 12, 111.
2. Oktay, K., Baltaci, V., Sonmezer, M., et al. (2015). Oogonial Precursor Cell-Derived Autologous Mitochondria Injection to Improve Outcomes in Women With Multiple IVF Failures Due
to Low Oocyte Quality: A Clinical Translation. Reprod Sci, 22(12), 1612-7.
3. Chowanadisai, W., Bauerly, K.A., Tchaparian, E., et al. (2010). Pyrroloquinoline quinone
stimulates mitochondrial biogenesis through cAMP response element-binding protein
phosphorylation and increased PGC-1alpha expression. J Biol Chem, 285(1), 142-52.
4. Ben-Meir, A., Burstein, E., Borrego-Alvarez, A., et al. (2015). Coenzyme Q10 restores oocyte
mitochondrial function and fertility during reproductive aging. Aging Cell, 14(5), 887-95.
5. Özcan, P., Fiçicio-lu, C., Kizilkale, O., et al. (2016). Can Coenzyme Q10 supplementation
protect the ovarian reserve against oxidative damage? J Assist Reprod Genet, 33(9),
6. El Refaeey, A., Selem, A., Badawy, A. (2014). Combined coenzyme Q10 and clomiphene
citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome.
Reprod Biomed Online, 29(1), 119-24.
7. Maged, A.M., Elsawah, H., Abdelhafez, A., et al. (2015). The adjuvant effect of metformin
and N-acetylcysteine to clomiphene citrate in induction of ovulation in patients with
Polycystic Ovary Syndrome. Gynecol Endocrinol, 31(8), 635-8.
8. Shokrpour, M., &Asemi, Z. (2019). The Effects of Magnesium and Vitamin E CoSupplementation on Hormonal Status and Biomarkers of Inflammation and Oxidative
Stress in Women with Polycystic Ovary Syndrome. Biol Trace Elem Res, 191, 54-60.
9. Visioli, F., Hagen, T.M. (2011). Antioxidants to enhance fertility: role of eNOS and potential
benefits. Pharmacol Res, 64(5), 431-7.
10. Kromhout, D., de Goede, J. (2014). Update on cardiometabolic health effects of ?-3 fatty
acids. Curr Opin Lipidol, 25(1), 85-90.
11. Beata Banaszewska, Joanna Wrotynska-Barczynska, Robert Z. Spaczynski, Leszek Pawelczyk, Antoni J. Duleba, Effects of Resveratrol on Polycystic Ovary Syndrome: A Double-blind, Randomized, Placebo-controlled Trial, The Journal of Clinical Endocrinology &Metabolism, Volume 101, Issue 11, 1 November 2016, Pages 4322–4328, https://doi.org/10.1210/jc.2016-1858
12. Toyama, K., Nishioka, T., Isshiki, A., et al. (2014). Eicosapentaenoic Acid combined with
optimal statin therapy improves endothelial dysfunction in patients with coronary artery
disease. Cardiovasc Drugs Ther, 28(1), 53-9.
13. Ruder, E.H., Hartman, T.J., Reindollar, R.H., et al. (2014). Female dietary antioxidant intake
and time to pregnancy among couples treated for unexplained infertility. Fertil Steril, 101(3),
14. Farzadi, L., Khayatzadeh Bidgoli, H., Ghojazadeh, M., et al. (2015). Correlation between
follicular fluid 25-OH vitamin D and assisted reproductive outcomes. Iran J Reprod Med,
15. Ozkan, S., Jindal, S., Greenseid, K., et al. (2010). Replete vitamin D stores predict
reproductive success following in vitro fertilization. Fertil Steril, 94(4), 1314-9.
16. Paffoni, A., Ferrari, S., Viganò, P., et al. (2014). Vitamin D deficiency and infertility: insights
from in vitro fertilization cycles. J Clin Endocrinol Metab, 99(11), E2372-6.


"BGI-Shenzhen, once known as the Beijing Genomics Institute, has burst from relative obscurity to become the world’s most prolific sequencer of human, plant, and animal DNA. In 2010, with the aid of a $1.58 billion line of credit from China Development Bank, BGI purchased 128 state-of-the-art DNA sequencing machines for about $500,000 apiece. It now owns 156 sequencers from several manufacturers and accounts for some 10 to 20 percent of all DNA data produced globally. So far, it claims to have completely sequenced some 50,000 human genomes—far more than any other group.
BGI quotes prices as low as $3,000 to sequence a person’s DNA. "


What is an Ovarian Cyst?
By definition, a “cyst” is a collection of fluid. Ovarian cysts are sacs of fluid which develop in the ovary. These fluid-filled collections can occur on one or both sides, and can be very small or grow to huge proportions. They can sometimes contain solid components, or they may be completely fluid-filled. While most ovarian cysts are benign, some cysts which form in the ovary can be malignant (cancerous).
Cysts are usually diagnosed by sonography (ultrasound).
This technique uses sound waves to “see” structures inside your body, and provides excellent images of fluid-filled structures like cysts. Ultrasound can be performed over your lower abdomen, or preferably, using a wand in the vagina. Transvaginal ultrasound is not painful, and allows us to see details of cyst structure, since it allows us to get so close to the cyst while viewing it. At The Woman’s Health Pavilion, each of our offices is equipped with modern, high-definition, 3-D ultrasound and staffed by experienced and certified sonography technicians; this allows us to see the fine detail in ovarian cysts. The details of cyst structure are important, because they help us to determine whether a cyst is benign or malignant. Cysts are often found using other types of imaging like CT scanning or MRI, but transvaginal ultrasound is still the gold standard for evaluating most ovarian cysts.
Types of Ovarian Cysts
There are dozens of types of ovarian cysts. Common types of cysts include:
- Functional cysts (commonly referred to as “ovulation cysts”)
- Dermoid cysts (benign cystic teratomas)
- Cysts associated with Polycystic Ovary Syndrome (PCOS)
- Cysts associated with ovarian cancer
Functional Cysts of the Ovary
The most common type of ovarian cyst is the “functional” cyst. Commonly referred to as “ovulation cysts,” functional cysts arise from the natural ovulatory function of the ovaries. Prior to ovulation, the cell destined to be released as the “egg” is recruited from among millions of other similar cells in the ovary. As the egg develops in the ovary, it grows within in a tiny collection of fluid called the follicle. Generally, when this collection grows to be about 1.5 centimeters (about the size of a grape) the microscopic egg is released from the follicle. The remaining collection of fluid resolves over the next several weeks, producing hormones which would serve to support a pregnancy if the egg were fertilized.
In some cycles, the collection of fluid around the egg will continue to grow for reasons which are not well understood. These “functional” cysts can grow to be quite large—more of a grapefruit than a grape—and can become quite painful. If they rupture, the pain is acute and severe, and will often result in trip to the emergency room. Because functional cysts produce hormones, women with a growing functional cyst will often notice changes in their menstrual cycle: menstrual bleeding may occur early or late, or may be unusually heavy or disorganized.
Functional cysts are usually diagnosed by transvaginal sonography performed in the office. During this test, a slender wand is gently inserted into the vagina, permitting close examination of the pelvic organs with sound waves, or ultrasound. Transvaginal sonography is not painful, and takes just a few minutes to perform. Functional cysts typically are seen as round, thin-walled structures in the ovaries filled with fluid or blood.
Importantly, functional cysts typically resolve without treatment. For women who are comfortable, it is perfectly appropriate to wait a cycle or two for the cyst to resolve. Of course, the ultimate proof that a cyst is simply “functional” is the fact that it does disappear. As such, follow-up is essential.
Traditionally, gynecologists have prescribed birth control pills to treat functional cysts. Recent evidence suggests that birth control pills do not make functional cysts disappear; being on birth control pills, however, does tend to prevent functional cysts from forming in the first place. Women who are prone to recurrent, symptomatic functional cysts will often benefit from staying on birth control pills, or similar hormonal contraception which suppresses ovulation.
Dermoid Cysts of the Ovary
The dermoid cyst (or technically, benign cystic teratoma) is unique because it grows tissues which belong in other organs. Commonly, for example, a dermoid cyst will contain hair, teeth, or fragments of bone. It may contain glandular tissue (e.g., thyroid tissue) which produces hormones. Usually, these solid components are encased in a thick capsule filled with an oily or cheesy liquid.
Dermoid cysts can be tiny, or grow to be huge. They are most often discovered in women aged 15 to 40, and in 15% of cases will be found in both ovaries. Because dermoids are dense and heavy, they tend to make the ovaries “dangle” in the pelvis. As such, they are particularly prone to torsion: An enlarged ovary containing a cyst will sometimes twist around its blood supply (think of a disco ball or an apple hanging on its stalk), interrupting the blood flow to the ovary. When blood flow to the ovary is interrupted, ovarian tissue rapidly begins to die. Torsion is extremely painful, and usually will result in an emergency room visit. Suspected torsion is a true surgical emergency.
Another common type of cyst in the ovary is an endometrioma or chocolate cyst. An endometrioma is a type of endometriosis, a condition in which the lining of the uterus (womb) flows backwards through the fallopian tubes and deposits in the pelvis. When this tissue deposits on the ovary, an endometrioma can form. Endometriomas are characteristically stubbornly attached to the ovarian tissue and filled with old thick blood, similar in consistency to chocolate syrup—hence the name “chocolate cyst”.
Endometriomas occur in women during their reproductive years, and are frequently seen in conjunction with endometriosis implants elsewhere in the pelvis. Sometimes, women with this condition will experience chronic pain, severe menstrual cramps, painful intercourse, or problems with fertility. Because endometriosis is a chronic condition, women may require ongoing treatment to prevent recurrence.
Many ovarian cysts—even large ones—are completely asymptomatic; other ovarian cysts may cause pain or pressure.
Polycystic Ovary Syndrome (PCOS)
Each month, the ovaries begin to develop several small follicles, tiny collections of fluid which each contain an egg. Early in the menstrual cycle, one follicle is “recruited”: This “dominant follicle” grows larger than the rest, and ultimately releases an egg at the time of ovulation. After ovulation, the follicle is termed a corpus luteum. If fertilization occurs, the corpus luteum will continue to produce hormones which support early pregnancy. If fertilization does not occur, the corpus luteum resolves, and ovulation is followed by a menstrual period two weeks later.
In women with PCOS, many follicles develop inside the ovaries, but an egg is not released regularly: Women with PCOS are usually either anovulatory (they do not ovulate at all) or oligo-ovulatory (they do not ovulate on schedule). Since ovulation is a prerequisite for pregnancy, women with PCOS frequently have difficulty conceiving. Also, since ovulation triggers the chain of events which leads to menstrual flow, women with PCOS often do not get regular periods.
The ovaries in women with PCOS have a characteristic appearance on sonography: The many developing follicles typically look like a “chain of pearls” clustered around the surface of the ovary. Usually, the ovaries are enlarged as a result of all the developing follicles.
Fundamentally, PCOS represents a hormonal imbalance: The ovaries in women with PCOS produce more androgens, or male hormones, than normal. As a result, women may notice increased hair growth on the chin or chest, acne, or thinning hair in a male baldness pattern. The “yin and yang” female hormones estrogen and progesterone are also out of balance: Women with PCOS produce too much estrogen and not enough progesterone. All of these changes contribute to menstrual irregularity and fertility issues observed in women with PCOS.
A woman’s body is designed to build up the inner lining of the uterus (the endometrium) each month, and then to clean it out each month with a period. Over a lifetime, constant buildup without a regular monthly cleanout increases the risk of endometrial cancer, a cancer in the lining of the uterus. Women with PCOS have an increased risk of endometrial cancer.
Ultimately, the precise cause of PCOS is not known, but several contributing factors have been identified. PCOS does seem to run in families: We often encounter sisters who each report having irregular periods and/or fertility problems. For many women, PCOS is caused by being overweight: Because fat cells are hormonally active, excess body fat disrupts a woman’s hormonal balance. It is well-known that overweight women who do not get their periods regularly will often resume regular monthly periods if they lose just 10% of their body weight.
In addition to weight loss, birth control pills are often used to “cycle” women with PCOS. Women who want to conceive may be offered medications which stimulate ovulation. Finally, because PCOS is linked to diabetes, certain medications which are commonly used to treat diabetes (e.g., metformin) may be used to treat PCOS.
Symptoms of Ovarian Cysts
Many ovarian cysts—even large ones—are completely asymptomatic; other ovarian cysts may cause pain or pressure. A slowly-growing cyst may produce mild or moderate pain, pressure, or heaviness over weeks to months, while a ruptured cyst may cause acute and severe pain that sends women to the emergency room. Pain may be constant or intermittent, or may occur only with activity or intercourse. Some women will also have bleeding abnormalities, since certain ovarian cysts produce hormones which can alter the menstrual cycle. Chronic complaints of bloating and vague urinary symptoms are also common among women with ovarian cysts.
When a cyst ruptures, the fluid contained inside is spilled into the pelvis and abdomen, causing pain. Technically, ovulation is a type of cyst rupture: In the ovary, eggs develop within a sac of fluid called a “follicle.” At the time of ovulation, the follicle ruptures, releasing the egg together with a small amount of fluid into the pelvis. While this process is completely normal, ovulation can be very painful for some women. Painful ovulation is known as mittleshmerz and is one of the more common reasons we see women in the emergency room. If you suffer from recurrent mittleshmerz, effective treatments are readily available.
Torsion occurs when the ovary containing a cyst twists around the “stalk” that contains its blood supply, like an apple twisting on a tree. When the blood supply of the ovary is interrupted, oxygen does not reach the ovarian tissue, and it begins to die. Like rupture of a cyst, torsion is severely painful, and may be associated with nausea, vomiting, and a low-grade fever. Torsion can often be diagnosed by a special Doppler ultrasound, which can demonstrate the lack of blood flow to the ovary. Torsion is a true surgical emergency.
Is it Cancer?
When women are diagnosed with an ovarian cyst, many will be concerned about the possibility of ovarian cancer. Ovarian cancer is indeed a frightening disease, one that affects 1 in 70 women in this country. Most women with ovarian cancer are first diagnosed when they already have advanced-stage disease. Unfortunately, this means that the prognosis of ovarian cancer is often not as favorable as many other types of cancer.
Certain women are particularly at risk for ovarian cancer. Age is an important risk factor: Ovarian cancer is rare before age 40; nearly half of ovarian cancers occur in women over age 63. Obese women have up to 50% higher risk of ovarian cancer. Women without children have a higher risk of ovarian cancer. Interestingly, women who spend a few years on birth control pills have a significantly lower risk of ovarian cancer.
Traditionally, ovarian cancer has been regarded as a “silent killer”: It has been widely taught that the disease has few early symptoms, and thus nearly impossible to catch in its early stages. While only about 20% of ovarian cancers are discovered in their early stages, recent studies suggest that most women with ovarian cancer do indeed have symptoms, even with early-stage disease.
The most common symptoms of ovarian cancer are:
- Abdominal bloating
- Pelvic and/or abdominal pain
- Feeling full quickly after eating
- Urinary urgency and/or frequency
In recent studies, almost all women diagnosed with ovarian cancer reported symptoms—although sometimes vague and non-specific—when carefully questioned. These recent findings underscore the importance of a careful medical evaluation for even vague pelvic and abdominal symptoms.
The diagnosis of ovarian cancer may be suspected based on findings of imaging studies like sonography, CT scan, or MRI. While none of these tests can tell the difference between benign cysts of the ovary and cancerous growths with 100% accuracy, ovarian cancers do tend to have a different appearance than benign cysts, especially on sonogram. Tumor markers in the blood (for example, CA-125) can be used in some women to gain additional information.
If a cancerous growth of the ovary is suspected, surgery is usually indicated. Ideally, surgery is performed in consultation with a gynecologic oncologist—a gynecologist with special training in the treatment of gynecologic cancers. Most women with ovarian cancer will require removal of both ovaries, together with the uterus, the fallopian tubes, the omentum (fatty tissue around the intestine), and lymph nodes in the abdomen and pelvis. Usually, chemotherapy is required after surgical staging.
Treatment of Ovarian Cysts
Typically, we make the diagnosis of an ovarian cyst using the high-resolution sonogram equipment located in each of our offices. Our equipment is modern, 3-D and Doppler capable, so we are able to collect as much information as possible about ovarian cysts and other types of pathology before you leave.
Once diagnosed, a treatment plan can be developed. For small cysts which are thought to be functional based on their sonographic appearance, patients may be asked to follow up after a few weeks. For larger cysts, or cysts with suspicious characteristics, further testing may be warranted. Testing may include additional imaging (for example, CT scan or MRI) or blood work which measures levels of tumor markers like CA-125.
Occasionally, it may be prudent to simply monitor a small cyst, but in most cases, persistent ovarian cysts will need to be removed. In most cases, ovarian cysts are removed laparoscopically, using a telescope inserted through your navel. This procedure, called laparoscopic ovarian cystectomy, is performed in the hospital, but patients are generally discharged the same day. Typically, women can return to their normal activities about one week after laparoscopic ovarian cystectomy.
There are many types of ovarian cysts, ranging from clinically insignificant to very serious in nature. Because there are so many types of ovarian cysts, any known or suspected ovarian cyst should be evaluated promptly by a gynecologist. The physicians at Woman’s Health Pavilion are well versed in the diagnosis and management of ovarian cysts, and can offer the most up to date treatments available. If you think you might have an ovarian cyst, we encourage you to call us as soon as possible.
May We Help You?
Would you like to find out more about our treatments and services? Are you looking for a second opinion on a diagnosis or treatment recommendation you received at another practice? The experienced team at The Woman’s Health Pavilion is happy to help. Just let us know how and when you’d like to hear from us.