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Endometriosis linked to reduction in live births before diagnosis of the disease, study finds

Until now, little has been known about the possible effects of endometriosis on fertility, especially in the years before a diagnosis

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Endometriosis may be linked to a reduction in fertility in the years preceding a definitive surgical diagnosis, researchers from Finland have found.

In the first study to look at birth rates in a large group of women who received a surgical verification of endometriosis, scientists discovered that the number of first live births in the period before diagnosis was half that of women without the painful condition, regardless of the form of endometriosis.

The research team also found evidence that the number of babies women had before endometriosis was diagnosed was significantly reduced, compared to women without an endometriosis diagnosis.

“Our findings suggest that doctors who see women suffering from painful menstruation and chronic pelvic pain, should keep in mind the possibility of endometriosis and treat them effectively,” said Professor Oskari Heikinheimo of Helsinki University Hospital, who led the study.

“Doctors should discuss with these women the possible effects on their fertility, in addition to the effects of their age, and the impairment of fertility should be minimised by offering relevant treatment for endometriosis without delay.”

Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes, affecting up to about 10 per cent of women of child-bearing age.

Typical symptoms include painful menstruation, pain in the pelvic area, difficult or painful sexual intercourse, and difficulty getting pregnant. Surgery has traditionally been the “gold standard” for diagnosing the condition and classifying the type of endometriosis, although diagnosis by ultrasonographic findings or the symptoms alone is currently accepted.

Until now, there has been little information about the live birth rate among women with endometriosis, and little is known about the possible effects of different types of endometriosis on fertility, especially in the years before a diagnosis.

“Given the chronic nature and typical long delay in diagnosis of endometriosis, we wanted to find out if there were differences in first birth rates before diagnosis in a large group of women in the population,” Professor Heikinheimo explained.

He and his colleagues looked at 18,324 women in Finland, aged between 15 and 49 years, who had surgical verification of endometriosis between 1998 and 2012. They matched them with 35,793 women of similar age who did not have an endometriosis diagnosis.

The follow-up period started at the age of 15 years, and continued until the first live birth, sterilisation, removal of the ovaries or womb, or until the surgical diagnosis of endometriosis, whichever came first.

The group of women with endometriosis were also divided into four groups according to the type of endometriosis.

A total of 7,363 women (40 per cent) with endometriosis and 23,718 women (66 per cent) without endometriosis delivered a live born baby during the follow-up period. The incidence rate of first live births among women with endometriosis was half that of women without the condition.

When analysed according to women’s birth decade from 1940s to 1970s, the birth rate decreased in both groups of women. Importantly, over the decades, an increasingly lower first live birth rate was seen in women with endometriosis, compared to women without.

In those women born in 1940-1949, the difference in live birth rates between the two groups was 28 per cent before surgically diagnosed endometriosis, but this difference increased steadily to 87 per cent by 1970-1979, the study showed.

“We assume that this is associated with the older age of women when they have their first baby, earlier surgical diagnosis of endometriosis and accumulating adverse effects of endometriosis in women affected by the condition,” said Heikinheimo.

“The possible effect of endometriosis on the desired number of children highlights the importance of early diagnosis and treatment of the disease,” he said, noting that the number of children that women had before their diagnosis of endometriosis was 1.93 and 2.16 for women without endometriosis.

“It is important to note that this study reports on live births before a definitive diagnosis of endometriosis,” the researcher added.

“Next, we will be reporting on the fertility rates after the surgical diagnosis and treatment of endometriosis. We hope that the fertility of women with endometriosis catches up with that of the women without the condition after surgical management.”

Although important, the study comes with some limitations. These include its focus on only surgically-confirmed endometriosis, which may have ruled out women with milder symptoms who were treated for the condition.

There were no data available on whether or not women wanted to become pregnant. The researchers could not rule out the possible effect of fertility treatments or the effect of adenomyosis, which is known to occur often with endometriosis, and which also affects fertility and pregnancy outcomes.

Differences in socioeconomic and educational backgrounds between the two groups of women might have also affected the findings, the researchers noted.

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Firm secures US$1.9m grant to support women entrepreneurs in Africa

eha Impact Ventures aims to support women-owned small- and medium-sized enterprises

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Evelyn Castle, chief executive officer at eHA Impact Ventures / Source: evelyncastle.com

The impact investing enterprise eHA Impact Ventures (EIV) has been awarded a US$1.9m grant from the non-profit organisation eHealth Africa (eHA) to support women entrepreneurs in Africa.

eHA’s board of directors approved the donation as part of its effort to “strengthen” healthcare delivery systems and support vulnerable populations.

The grant, the organisation said, will be deployed to “upscale” women-funded companies to improve the health and wealth of African women, their families and their communities.

The donation is hoped to address the US$42bn funding gap for women entrepreneurs in Africa and help female founders have better access to funding opportunities.

In addition, the funds are expected to support health interventions like the pre-screening of cervical cancer and improve delivery of blood and blood products to healthcare facilities.

“The grant will be instrumental in boosting the economic capacity of women across Africa by supporting high-impact women-owned businesses,” said Evelyn Castle, chief executive officer at EIV, who founded the firm in 2021.

“Furthermore, it will [help us] upscale funding, mentorship and training programmes to help women create thriving businesses that drive economic growth in their communities.”

My Le, board executive at eHealth Africa, said: “These donations could not have come at a better time as  women continue to struggle to meet up with both health and economic demands. Thus we are optimistic that the funds will go a mile in bridging fiscal gaps for women and other vulnerable groups to lead healthier lives.

“Supporting women will go a long way in not just improving their societal impact but also contribute immensely to sustainable development especially in the African region.”

Recognising women’s “vital” role in building strong health systems, Atef Fawaz, CEO of eHealth Africa, added: “We acknowledge the profound impact women have in strengthening healthcare systems, aligning with our vision at eHealth Africa.”

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Menstrual product wins innovation award in Switzerland

Egal’s innovation consists of a roll of pads that operates in a similar fashion to a toilet paper roll and comes in its own dispenser

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Penelope Finnie, chief executive officer at Egal

Pads on a Roll, a menstrual product that can be dispensed in public stalls similar to a toilet paper roll, has won a prestigious award at the Women’s Health Innovation Summit Europe in Basel. 

Each year the Women’s Health Innovation Summit (WHIS) helps promising start-ups raise their brand awareness and pitch their solutions in front of investors and industry leaders.

Egal, the company behind Pads on a Roll, has been honoured with this year’s Women’s Health Innovation award after the WHIS selection committee recognised the start-up as an innovative company poised to disrupt the European women’s health landscape.

“Egal Pads is so honoured to have been chosen for the Women’s Health Innovation Award,” Penelope Finnie, Egal chief executive officer, told Femtech World.

“The other nine finalists were amazing companies run by wonderful people. The whole conference was a testament to the importance of the femtech movement.

“For us, it was particularly exciting as the EU is the next market we are focusing on. We hope that having period products available in stalls just like toilet paper is, will become the norm as it is necessary for equality.

“We also hope that by winning, it brings attention to this easily solved but long ignored issue,” Finnie added.

Egal’s innovation consists of a roll of pads that operates in a similar fashion to a toilet paper roll and comes in its own dispenser.

Egal aims to sell Pads on a Roll to universities and public schools

Each roll contains 40 pads and can be placed directly in stalls, unlike the typical tampon dispensers that often require money to access the products and are located outside the stall.

The pads are less expensive to maintain than products in vending machines because they are easier to refill, and require less space and packaging.

Research shows that 20 percent of girls in the US and UK have missed school due to lack of access to period products, with more than 90 per cent of menstruators having experienced jammed, broken or empty dispensers in public toilets.

Egal aims to solve this issue by selling Pads on a Roll to universities and public schools.

The Boston-based company has done pilots at various universities across the US and is hoping to develop a flushable version of the product in the future.

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‘It’s hard to stay healthy’- experts raise alarm over ‘pervasive’ economic challenges in US

A report highlighting women’s struggle with economic stress in the US has prompted experts to demand change

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Experts have raised concerns over the “pervasive” economic and health challenges women in the US are facing, after a damning report exposed significant financial stress.

national survey of women over 25 has found that American women face significant economic stress, with half of women reporting feeling “uncertain” or “worried” when thinking about how to pay for healthcare later in life and low-income and rural women reporting challenges to staying healthy today.

The report, which highlighted financial difficulties among women for the second year in a row, has prompted experts to speak out and demand change.

“The recent findings from the National Council on Aging (NCOA) and Women’s Institute for a Secure Retirement (WISER) underscore the pervasive economic and health challenges confronting American women, particularly those from low-income and rural communities,” Georgie Kovacs, women’s health expert and founder of Fempower Health, told Femtech World.

“Many women juggle caregiving responsibilities for their children while managing employment, often in environments that offer limited support.

“The scarcity of healthy food options in low-income areas, coupled with restricted access to essential healthcare services, exacerbates their daily struggles, impacting both their mental and physical health and that of their families.”

Underlining the “profound” impact of the menopause transition, Kovacs said women across the country are in desperate need of enhanced workplace policies and better access to specialised care.

“Our approach to addressing these challenges cannot be piecemeal – we require comprehensive systems that integrate childcare, health services, job security and mental health support, ensuring that no aspect of a woman’s health is overlooked,” she explained.

“It is imperative that we view the economic insecurities faced by women through a holistic lens, recognising the interconnectedness of health, employment and wellbeing.

“It’s time for all stakeholders, including government bodies and private sectors, to unite in crafting and implementing solutions that are as multifaceted as the lives of the women they aim to support.”

Katie Higgins, chief commercial officer at fertility benefits platform Progyny, called on employers to do more to support women, arguing that the pressure of financial uncertainty could “erode” self-esteem, strain relationships and compound parental stress.

“Balancing financial pressures with caregiving responsibilities can heighten feelings of guilt and inadequacy, impacting maternal mental health.

“Employers play a vital role in empowering women to prioritise their health without financial barriers through comprehensive benefits that include family building, fertility, maternal leave and menopause.”

Lois Quam, chief executive officer at sexual and reproductive health organisation Pathfinder International, noted that there is an important connection between health and income, meaning that women with the least financial resources often find themselves unable to access health services and modern innovations.

“From rural areas to the wealthiest cities in the world, women everywhere are being left behind. In the US and globally, they get paid and promoted less than men and leave the workforce at greater numbers to raise their children.

“Closing the gender pay gap could help keep women in the workforce, especially when childcare is so costly and inaccessible,” she told Femtech World.

Author and women’s health expert, Dr Mindy Pelz, encouraged women to “take control” of their health.

“It’s hard to stay healthy, even without the added pressure of economic stress,” she said.

“Many women just can’t rely on the American healthcare system to take care of them. That’s why I’m such an advocate for taking your health into your own hands.

“Simple lifestyle changes like intermittent fasting, meditation, cold exposure, walking 10,000 steps a day, avoiding electronics before bed might seem small on their own, but if you add them together and are consistent with them over time, they can make a huge difference.”

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