News
Menstrual cycle may contribute to sickle cell disease pain crises, study finds
A marker linked to inflammation, C-reactive protein, may increase significantly during the follicular phase of the menstrual cycle in female patients with sickle cell disease (SCD), according new research.
This observation provides insight into the pattern of painful vaso-occlusive events (VOEs), which are driven by inflammation, in female patients with the disorder.
Jessica Wu, MD is a resident physician in the Department of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania and lead author of the study.
Wu said: “We know both from the literature and anecdotally from our patients that women with SCD have VOEs that cluster around their menstrual periods.
“We wanted to examine the potential reason behind that.
“Our study is the first to examine the association between menstrual cycles and inflammation in female patients with SCD.”
Dr Wu, Dr Andre Roe, and their colleagues analysed plasma samples in the Penn Medicine BioBank repository from individuals with a confirmed SCD diagnosis.
After excluding samples from participants who were pregnant, hospitalised with a VOE, or treated at an emergency department or infusion centre at the time of sample collection, 31 plasma samples were included in their analysis – 13 from female patients and 18 from male patients.
SCD, the most common inherited red blood cell disorder in the United States, is characterized by abnormally shaped blood cells.
These cells can become lodged in the veins and block blood flow, leading to organ damage, infection, and episodes of severe pain throughout the body, known as VOEs, which can be so debilitating that people seek treatment at a hospital.
Previous literature has shown that female patients with SCD have more frequent, severe VOEs, often around the time of their menstrual periods.
The researchers measured C-reactive protein in all samples and female sex hormones, including estradiol, progesterone, and luteinizing hormone, in samples from female patients.
They compared C-reactive protein, clinical laboratory markers, and other biomarkers by patient sex, SCD genotype, hydroxyurea, and, in the cases of the 13 female patients, made the same comparisons between samples from the follicular and luteal phases of the menstrual cycle.
A progesterone level of 1.75 ng/mL was used to define the occurrence of ovulation and cutoff between the follicular and luteal phases.
Among the 31 samples, the average concentration of C-reactive protein was 4.45 mg/L, with no significant differences observed based off SCD genotype or treatment with hydroxyurea.
When Dr Wu and her colleagues compared C-reactive protein between samples from female patients and male patients, they observed no significant difference (3.88 vs. 4.45 mg/L, p=0.89).
However, when they compared C-reactive protein between samples taken during the follicular or luteal phases of the female patients, they observed higher median C-reactive protein in the follicular phase versus the luteal phase (8.80 vs. 0.82 mg/L, p=0.03).
Dr Wu said: “The amount of inflammation is significantly elevated in the follicular phase, or first half, of the menstrual cycle in female patients with SCD.
“This observation correlates with what we see in the literature, that this is the time in which this patient population has the most VOEs.”
These results also mirror the trend seen in the menstrual cycles of the general population, though the magnitude of elevation is much greater in female patients with SCD than in those without SCD during the follicular phase (8.80 mg/L vs. 0.74 mg/L).
The significant fluctuation of C-reactive protein in female patients with SCD could have clinical implications given the similar temporal pattern of VOEs, providing a target for intervention.
Dr Wu said: “Many hormonal contraceptives can suppress menstruation or suppress the hormone fluctuations that occur from cycle to cycle, so contraceptives could help these patients manage their pain crises.
“SCD is a really debilitating and painful disease. The more data we have about how it presents in female patients, the better we can counsel them on anticipating and managing their pain.”
The researchers intend to validate their findings through further prospective studies with larger sample sizes and plan to explore menstrual patterns of other biomarkers associated with SCD, as well as correlation with clinical symptoms.
Perimenopause misinformation on social media is putting women at risk of unintended pregnancies, unnecessary medication and missed diagnoses, experts have said.
Awareness of menopause and treatments such as hormone replacement therapy, or HRT, has been raised by efforts including a prominent documentary by Davina McCall.
But as a growing number of women encounter misleading information on social media, there are concerns that some could be led to false conclusions that can obscure real underlying health difficulties.
“Everyone thinks they’re menopausal,” said Dr Paula Briggs, a consultant in sexual and reproductive health.
“So we are seeing younger and younger women asking for HRT when what they need is hormonal contraception, as they’re still fertile.
“I work in an abortion service and we’re seeing more women over 35 now who believe themselves to be menopausal and are gobsmacked when they become pregnant.”
According to the British Menopause Society, more than 80 per cent of women will be menopausal by the age of 54, meaning they have not had a period for 12 months or more, with about 5 per cent reaching menopause before the age of 45.
But menopause is not a sudden stop. Instead, women go through a transition known as perimenopause over months or years.
During this time, hormone levels fluctuate and can cause symptoms such as changes in menstrual patterns, hot flushes and difficulty sleeping.
Briggs said misinformation around perimenopause is concerning.
“I look at things like Instagram to see what they are exposed to and I am horrified,” she said, citing examples of women in their 30s being told to demand HRT if they are unable to sleep or are struggling with migraines, and to switch GPs if denied.
Or women being told they should seek testosterone treatment.
“I’m not anti any of these things in the right person, but females produce their own testosterone lifelong, even women without ovaries, so the idea that everybody has to demand testosterone is bonkers,” Briggs said.
Dr Channa Jayasena, an expert in reproductive endocrinology at Imperial College London, also raised concerns.
“It’s great that there’s better [public] awareness [about perimenopause]. And I think many doctors are completely unaware about how debilitating the symptoms of perimenopause can be,” he said.
“But the flipside of that, I think there’s a risk that some women are being mislabelled as having perimenopause when they have other things that are wrong.”
Prof Janice Rymer, chair of the British Menopause Society, agreed.
“[If you are] having regular periods naturally, then you’re not perimenopausal, end of story. You’ve got good hormone levels,” she said.
Rymer added that there is a perception that any symptom affecting women between the ages of 40 and 60 is due to perimenopause or menopause and that HRT is required.
“I think HRT is completely wonderful,” Rymer said. But, she added, “it’s not for women who don’t need it,” noting that in such situations it can cause heavy bleeding.
Briggs said a key concern arising from misinformation around perimenopause is that women are stopping contraception, thinking it is no longer needed.
Jayasena suggested that could be because of messaging around how fertility declines with age.
“I think we’ve got a real awareness about the timelines for optimum fertility and optimum response for IVF. IVF stops working well beyond the age of 42. It’s easy to translate that to an assumption that you can’t get pregnant naturally, when actually you can,” he said.
Experts have also raised concerns over a pushback against hormonal contraception, something that is particularly acute among younger women, even though demand for HRT is growing.
While they stress contraception is not a one-size-fits-all issue, Briggs noted there are many progestogen-only contraceptives, which use a synthetic version of the hormone progesterone, that can be used alongside HRT to protect against pregnancy while managing symptoms associated with perimenopause.
In addition, she said, there are modern forms of the combined pill that are safer for use in women experiencing perimenopause than traditional combined pills, as they contain a natural form of oestrogen.
Essentially, said Jayasena, “it’s a mini pill plus a bit of HRT.”
Dr Zara Haider, president of the College of Sexual and Reproductive Healthcare, said misinformation is a significant issue, particularly around fertility and hormone use.
She said: “We still see women stopping contraception too early because they assume they can’t get pregnant, when in reality contraception is needed until menopause is confirmed or until age 55.
“There’s also been a lasting impact from outdated or flawed studies around risks like breast cancer, which has understandably made some women cautious about hormones.
“At the same time, it’s positive that public conversations, including high-profile campaigns, have helped bring menopause into the mainstream.
“The challenge now is making sure women are getting accurate, evidence-based information to make informed decisions.”
An early PET scan after one cycle of chemotherapy may help predict how aggressive breast cancer responds to treatment, a study suggests.
Research led by The Institute of Cancer Research, London and King’s College London suggests that an early scan taken after one cycle of chemotherapy could help predict how well a patient’s cancer will respond to treatment.
The study focused on patients with triple-negative breast cancer (TNBC), an aggressive form of the disease in which cancer cells lack receptors for the hormones oestrogen and progesterone, as well as the HER2 protein.
Patients with TNBC are usually treated with chemotherapy prior to surgery. While many respond well, residual disease at surgery, typically around six months later, is associated with a significantly poorer prognosis. Identifying people sooner who are unlikely to respond remains a major clinical challenge.
The research explored whether using PET imaging shortly after treatment begins, rather than relying only on MRI scans later in the treatment process, could provide earlier insight into how a patient’s cancer is responding. Twenty-two patients were recruited, with fourteen undergoing FDG-PET scans before treatment and after the first cycle of chemotherapy.
The findings, published in Clinical Cancer Research, showed that changes seen on PET scans after just one cycle of chemotherapy were strongly associated with subsequent response, including whether there was no detectable cancer, known as a complete response, by the end of treatment. Importantly, early PET response showed stronger associations with treatment outcomes than standard mid-treatment MRI scans in this study.
Being able to identify patients who are not responding well at an early stage could allow clinicians to adjust treatment sooner or consider alternative approaches. These findings may also support future strategies to better tailor treatment intensity to individual patients.
The study also compared two types of PET tracers, FDG and FLT, to determine which was most suitable. While both met the study’s technical criteria, FDG-PET was selected for further evaluation due to its better image quality, greater consistency and wider use in clinical practice.
The research also explored how imaging changes after just one cycle of chemotherapy relate to the body’s immune response to treatment. Biopsies taken before and after the first cycle of chemotherapy showed that an increase in immune cells within the tumour was strongly associated with both early PET changes and improved treatment outcomes.
The researchers emphasise that these findings now need to be validated in larger studies. Future work will aim to confirm these results in broader patient groups and explore more accessible imaging approaches, such as ultrasound, alongside PET and MRI.
Sheeba Irshad, professor of cancer immunology at King’s College London and lead of the Breast Cancer Now KCL Research Unit, said:
“In patients who had PET scans both before treatment and after the first cycle, we found that this early scan could predict whether they were likely to achieve a complete response by the end of treatment. These findings highlight the potential of early imaging to guide treatment decisions, and now need to be validated in larger, modern clinical trials.”
Andrew Tutt, professor of breast oncology at The Institute of Cancer Research, London, said:
“Research that helps us determine early who is already benefitting from standard neoadjuvant chemotherapy and who might benefit from clinical trials to find better treatments is vital. This study shows that FDG-PET may have great value in this regard. We hope to be able to design studies that further investigate and validate these findings.”
The study was supported by funding from King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, Breast Cancer Now, Cancer Research UK, and Guy’s and St Thomas’ Charity.
We are excited unveil the three finalists competing for one of the Femtech World Awards’ most coveted honours: the Startup of the Year Award, sponsored by Future Fertility.
This award celebrates an early-stage company making a bold impact in women’s health through innovation, vision and execution.
The winner will be announced at our virtual ceremony on 19 June, with the decision made by a representative from category sponsor Future Fertility.
Congratulations to the shortlist and thank you to everyone who entered or nominated.
Startup of the Year Shortlist
Hello Inside is the first women’s health AI company to turn daily metabolic signals into outcomes women feel and healthcare systems reimburse.
Women’s health has long been under-researched, and current AI benchmarks fail on women’s health questions roughly sixty percent of the time.
Hello Inside built the architecture to close that gap.
Across four years and 12,000+ validated metabolic profiles, three in four women improve at least one symptom within ninety days.
They lose four kilograms in three months, moving from overweight into the healthy range. In a clinical study with Alisa Vitti’s Flo Living, 91.9 per cent reduced PMS burden within sixty days.
U-Ploid is an early-stage biotechnology company tackling one of the most fundamental challenges in fertility care: the sharp, age-related decline in egg quality that limits outcomes across IVF and egg freezing.
While much of the field focuses on improving assessment and selection, U-Ploid is developing a first-in-class therapeutic approach designed to improve egg quality itself by addressing the biological causes of age-related chromosomal errors.
Supported by strong preclinical evidence and now advancing into human studies, U-Ploid combines scientific rigour, regulatory discipline and long-term vision to help redefine what is possible in fertility care.
News4 weeks agoWomen’s digital health market set to reach US$5.28 billion in 2026 – report
Insight4 weeks agoWhy the UK’s fertility rate keeps falling – and what it means if you’re trying now
Wellness4 weeks agoWomen’s HealthX unveils Northwell Health, Corewell Health, Biogen & more to headline Chronic Disease stage
Motherhood3 weeks agoWhat Maternal Mental Health Month reveals about where postpartum support actually breaks down
Fertility4 weeks agoToxins and climate harms having ‘alarming’ effect on fertility, research warns
News3 weeks agoNIH Grant terminations disproportionately impact minority scientists, research finds
Adolescent health3 weeks agoWUKA brings Period-Positive Pool Party to London Aquatics Centre to keep girls swimming through puberty
Fertility4 weeks agoResearcher explores weight loss jab impact on PCOS