By Daw News/AFP

Amid rising concerns, medical experts say the situation is different and less worrisome this time.

Exactly five years after the Covid-19 pandemic upended the world, concerns have once again risen over the spread of a flu-like virus in China and other neighbouring countries.

Beijing has recently reported a surge in cases of the human metapneumovirus or HMPV, a respiratory infection, with the government attributing it to a seasonal spike. Social media is abuzz with images of hospitals overrun with masked patients.

But medical experts say the situation is different and less worrisome this time. Here’s what we know of the virus so far.

What is HMPV?

According to Dr Fyezah Jehan, head of Paediatrics and Child Health at the Aga Khan University, HMPV is known to cause upper respiratory tract infections and has flu-like symptoms such as cough, nasal blockade, wheezing, and fever. However, it could increase risks or lead to serious complications such as pneumonia among the elderly, young children, and immunocompromised people.

She explained that HMPV was less severe. “We are only measuring it now. Unlike influenza, this virus did not have a testing and surveillance system.”

HMPV spreads by touch, through direct contact with an infected person or exposure to contaminated surfaces. “Covering the mouth and nose while coughing, washing hands and maintaining distance will all help,” Dr Jehan said.

Infected people should rest and monitor their symptoms, she suggested, adding that there was no particular cure or vaccine for the virus and its treatment was focused on the management of symptoms.

Symptoms

• Cough
• Wheezing
• Nasal blockage
• Fever
• Pneumonia in young children, elderly, immunocompromised people

Precautions

• Stay at home to rest and avoid infecting others
• People with severe symptoms seek medical care as soon as possible
• Wear masks in crowded or poorly ventilated spaces
• Cover coughs and sneezes with tissue or bent elbow
• Practice regular handwashing

Not like Covid

Unlike Covid-19, which was unknown when it first emerged, the HMPV has been around for decades. As per research, HMPV has circulated for at least 65 years, and nearly every child will be infected with HMPV by the age of five.

The virus “is part of the cocktail of winter viruses that we are exposed to”, AFP quoted John Tregoning, professor in vaccine immunology at Imperial College London, as saying.

Highlighting distinctions between the two viruses, Dr Jehan said that HMPV was always localised and could be controlled through standard hygiene.

Covid, on the other hand, caused excessive outbreaks and needed lockdowns, masks, and vaccines. Similarly, HMPV without symptoms was rare while in Covid the spread from asymptomatic individuals was very common.

From China to India

The Chinese authorities have acknowledged the uptick in HMPV cases but at the same time emphasised that the virus is not a major concern.

At a news conference on Dec 27, the director of China’s Institute for Infectious Diseases said HMPV cases were rising among children aged 14 or younger. Kan Biao stated that the increase was notable in the northern parts of the country.

Cases could spike during the Lunar New Year holiday, at the end of January, when many people travel and gather in large groups, he added.

According to the Xinhua news agency, HMPV cases have been on the rise in China since mid-December in both outpatient and emergency departments. The government has also set up a monitoring system for pneumonia of unknown regions.

Seven cases of the virus have also been reported in India, where the health ministry has asked each state to flag any influenza-like illness and severe acute respiratory infection.

WHO’s recommendations

Meanwhile, the World Health Organisation (WHO) has said that the rising cases of common respiratory illnesses in China and other areas around the Northern Hemisphere were within the range expected for winter, with no unusual outbreaks reported.

In a statement on Tuesday evening, the body said it was in contact with Chinese health officials and had not received any reports of unusual outbreak patterns there.

The WHO said Chinese data up to Dec 29 showed detections of HMPV, seasonal influenza, rhinovirus, and respiratory syncytial virus (RSV) have all increased in recent weeks, particularly in northern parts of China. Influenza is currently the most commonly reported cause of disease, it said.

The observed increases in acute respiratory infections and associated pathogen detections in many countries in the Northern Hemisphere in recent weeks are expected at this time of year and are not unusual, the WHO noted.

It recommended that individuals take normal precautions to prevent the spread and reduce risks posed by respiratory pathogens, especially to the most vulnerable.

What should Pakistan do?

First of all, don’t panic, said Dr Jehan.

She stated that Pakistan had a network of influenza surveillance centres located in Punjab and Islamabad, which should be used to monitor these cases.

At the same time, the government should also launch a public awareness campaign which should educate people about the precautionary measures in line with the WHO’s recommendations, she said.

Courtesy: Dawn News
By Abeer B

There’s little understanding of and even less research on the condition, but one doctor estimates that approximately one in 20 Pakistani women has vaginismus.

our husband is going to leave you, yeh mai app ko likh ke deti hoon [mark my words], is what 29-year-old Laiba* was told when she went to an experienced and well-reputed gynaecologist in Karachi. Laiba, now 34, still remembers those words. “It wasn’t the choice of words that cut deep; it was the tone, the absolute lack of empathy this woman showed me, the shame she meant for me to feel.” Laiba recalls how she sat there frozen, unable to voice her concerns.

“Jo aurat apna basic kam nah ker paye [A woman who isn’t able to fulfil her basic responsibilities]…I suggest you grow up and stop being a silly schoolgirl.”

It took Laiba almost another two years to mentally prepare herself to see another gynaecologist. She recalls going home from the clinic in tears, “My mother kept reassuring me that my husband would do no such thing as I sobbed in the waiting room and then in the car on the way home. Of course, I knew my husband wouldn’t leave me, but what I couldn’t explain to my mother was that my husband wasn’t the issue. The truth was, it had taken me an entire year to muster the courage to talk about something that had so much shame attached to it.” She waited another two years before visiting another gynaecologist. “I remember asking the friend who had been to her if she was kind. Can you imagine? That is the bare minimum I was expecting.”

The second doctor listened to Laiba’s journey since her marriage and, after examination, diagnosed her with vaginismus. “I was so relieved. I mean, it’s strange to hear someone being relieved upon hearing that they have a serious medical condition, but I felt so alone and I finally received validation that there was a term for what I had and I wasn’t alone in it,” Laiba recalls, with a flood of happy tears.

So what exactly was Laiba diagnosed with? According to the NHS, vaginismus is when the vagina suddenly tightens up when you try to insert something into it. It can be painful and upsetting, but it can be treated. Vaginismus is most common in women in their late teens to early 30s but anyone with a vagina can get it.

Dr Mala Jitendra Shahani, a consultant obstetrician and gynaecologist based out of Altamash General Hospital in, Karachi, offers a detailed explanation of this condition. According to Dr Shahani, vaginismus manifests as an automatic and uncontrollable response when penetration is attempted. The muscles around the vagina tighten or go into spasm without any conscious control from the woman. This reaction is entirely involuntary and occurs specifically when something is being inserted during intercourse.

Dr Shahani notes that in her practice, she frequently encounters women who use various methods to manage this condition. They may use menstrual cups, tampons, or other devices without problems. However, when it comes to sexual intercourse or other forms of penetration, the involuntary muscle contractions persist. This condition, known as vaginismus, is thus characterised by an unintentional and reflexive muscle spasm, which complicates the experience of penetration.

Why does it happen?

According to Dr Shahani, vaginismus is a psychosomatic response — an interaction between mind and body. The body anticipates pain with penetration, leading the vaginal muscles to contract and go into spasm. This can occur due to various psychological and physical reasons, but it is primarily psychological, often rooted in societal stigma surrounding sex.

In many cultures, sex and intercourse are considered taboo subjects. Dr Shahani explains that the first impression many girls have of sex is something painful and unpleasant. “Our mothers, grandmothers, sisters, and relatives often discuss this topic in a very negative light, which psychologically embeds discomfort and pain in many young girls’ first impressions of intercourse.”

Dr Omema Akhtar, a consultant gynaecologist at the Jinnah Postgraduate Medical Centre in Karachi, says, “Almost every woman, to some extent, experiences this, but some overcome it while [for] others [it] persists.” She explains that although there is no statistical data available, “roughly speaking, in every two clinics, one patient presents with a history of vaginismus.” The doctor emphasises that it is not a particularly challenging condition to treat effectively.

She compares vaginismus to erectile dysfunction — neither of these conditions are in the control of the person suffering from it. Dr Akhtar adds that there is nothing to be ashamed of if someone struggles to overcome this problem. “There is no fault of the woman in this, because it is involuntary and not in her control at that time.”

According to a study published in the Journal of South Asian Federation of Obstetrics and Gynaecology, the worldwide prevalence of vaginismus is reported to be in the range of one and seven per cent. In clinical settings in the US, the prevalence of vaginismus in contemporary population ranges from five to 17pc. Studies conducted in Egypt report vaginismus as 20pc. The study noted that no previous research had been conducted on vaginismus in India. It surveyed 160 married women in India’s Karnataka and found 28pc had primary vaginismus while 30pc had secondary vaginismus.

Apart from a few limited studies, there is no official data on how many women suffer from the condition in Pakistan, but based on her own experience, Dr Akhtar estimates that approximately one in 20 women has vaginismus.

Discussions about sex and pleasure are rarely healthy in Pakistan. Sex is often portrayed as something dirty and unmentionable, associated with pain, tearing, and bleeding. This negative portrayal can lead to fear and apprehension about sexual experiences.

According to Samia Khan, a licensed professional counsellor, licensed marriage and family therapist, and certified sex therapist with her own practice in Wisconsin, USA called the Whole Hearted Wellness, “Cultural and religious backgrounds contribute to the development of vaginismus. Essentially, the idea is that our mind and body are deeply connected, especially regarding emotions and physical experiences. When society sends messages that make intimacy taboo, we internalise the belief that it is something we should avoid or not engage in. Consequently, when we are married and ready to be intimate with our partner, we might struggle due to these ingrained perceptions”.

She adds how our body says “no” because our mind has been conditioned to view intimacy as bad, dirty, or inappropriate for girls. As a result, our body reacts to these internalised beliefs by physically resisting, leading to pain and muscle spasms that prevent penetration. In her opinion, these factors can definitely worsen vaginismus.

Meanwhile, Dr Shahani notes that previous trauma from sexual assault or rape can significantly contribute to this fear.

Misha*, 36, reflects on her childhood sexual abuse, noting, “I grew up in an environment where the burden of sexual abuse was placed on the victim. Although I knew deep down it wasn’t my fault, I chose to suppress the trauma. After marriage, I struggled with intimacy; my husband felt like there was a wall he couldn’t get past anytime penetration would take place between us. I initially thought I had a physical deformity, but after a consultation with a surgeon, I was told I had vaginismus.” Misha’s diagnosis was pronounced in the US, and she is thankful for the opportunity to move there after her marriage. She recognises that had she remained in her hometown of Gujranwala, she likely would have received little to no support.

But while sexual assault or abuse can contribute to the condition, it isn’t the only reason for it.

Anum*, 27, recalls how her gynaecologist did diagnose her with vaginismus but dismissed it. “She insisted I was sexually abused as a child but I was not admitting to it or had repressed it. I didn’t, but she wouldn’t buy it, so I changed doctors until I found someone who understood this was beyond my control and it wasn’t a condition that was an outcome of abuse.”

But how does one find out they have a condition that no one wants to speak about? “We Google everything, don’t we? From how to make a pancake to fixing the geyser —everything. So this was very natural,” recalls Ayesha* an A-level math teacher. “All I had to type in was ‘fear of penetration’ and lo and behold, I was introduced to not just the term vaginismus but a whole community very willing to help. However, I found it a little difficult to connect culturally with these white people who were surprised I lost my virginity at 25 and had never explored my body per se.”

That is when Ayesha realised she needed people who would understand her issues in a language and culture where she did not have to struggle as much. “I Google everything and it’s an instant problem solver — things I am ashamed of, things I wouldn’t even say aloud to my husband, but that is a privilege I have. I sympathise with our mothers who navigated life without this very useful tool.”

The road to recovery

Anxiety surrounding penetration can worsen the condition. Treatment options for vaginismus often involve a combination of physical therapy to relax the pelvic floor muscles and psychotherapy to address any underlying anxiety or fear.

Counsellor Khan believes a physical therapist specialising in pelvic floor therapy can help address vaginismus by working to relax and exercise the pelvic muscles. This can be particularly beneficial when psychological impacts or past traumas, such as childhood sexual abuse, contribute to muscle spasms and physical blockages. By normalising these treatments and making such resources more available, we can better manage the guilt and shame prevalent in our culture.

When considering whether vaginismus is physical or psychological, Dr Shahani clarifies, “In medical terms, when physical factors are involved, we refer to it as dyspareunia, not vaginismus. Vaginismus primarily involves the contraction of the muscles. Dyspareunia is used to describe pain during intercourse when physical factors are present. Vaginismus, on the other hand, is mainly psychological, with the underlying cause often being psychological.”

Physical factors like previous childbirth or conditions such as vaginal lesions, tumours, atrophy, or narrowing can contribute to discomfort and pain, but these are often secondary to the primary psychological causes. Vaginismus may involve muscle spasms during attempted penetration, and sometimes hymen abnormalities can also play a role.

To treat vaginismus, Dr Shahani employs a multidisciplinary approach involving a psychologist, physiotherapist, sex therapist, and sometimes a neurosurgeon for pain management. Medications can also help — topical gels can numb pain, while muscle relaxants in ointment form or Botox injections can relax the muscles. Anti-anxiety medications prescribed by a psychiatrist may also be beneficial, depending on the patient’s history and condition.

Khan also believes that there no one way approach for curing the condition. Talk therapy or psychotherapy alone may not be sufficient. Combining it with pelvic floor physical therapy can address both the psychological and physical aspects of these conditions.

While talk therapy helps with the mind-body connection, pelvic floor therapy targets muscle relaxation and pain management. Research indicates that vaginismus is not solely psychological; it involves real physical pain and muscle spasms that need to be treated both mentally and physically.

Dr Shahani’s treatment physical protocol includes the use of vaginal dilators, starting with the smallest size. She often instructs the patient’s partner to assist with dilation in the clinic, as some patients feel more comfortable with their partner’s support.

Dr Shahani suggests using candle sticks as an alternative to expensive silicone dilators, noting that candles come in various sizes and the wax is generally gentle on the skin.

She emphasises that a supportive partner is crucial to overcoming vaginismus. The doctor has observed that some couples may separate or divorce if the condition is not managed effectively. Patience is key, as it can take up to three years for some couples to successfully manage penetration.

Dr Akhtar agrees: “As long as there is no supportive partner, the treatment of vaginismus can be challenging. I have seen patients whose partners were not understanding at all. These women came to us for the treatment of vaginismus and were able to insert dilators on their own. However, when their partners approached them, they were unable to allow it.

“How can they, when there is no mental or emotional understanding? When there is no spark in their relationship, how can a woman feel ready to allow her partner to be intimate? That’s why vaginismus treatment often involves both partners — it’s a couple’s treatment. Doctors recommend that once we treat vaginismus, couple’s counselling and participation become very important.”

Hamnah*, now 33, got divorced when she was 21. “I got divorced fairly young. I was married to a friend of the family who was 11 years my senior. Before my wedding night, I had no concept of physical intimacy, let alone ever having spoken to a boy. The opposite gender was alien to me and I didn’t know what to expect.

“On the wedding night he forced himself on me. I broke my hymen in the most painful way possible, and after that, I wouldn’t let him touch me — I was so traumatised. Every time he would initiate intimacy, I would start shivering and crying to the point where my in-laws got involved. After six months of this ordeal, he dropped me off at my parents’ place and sent divorce papers before I turned 22.” Hamnah has not remarried.

Much to learn

The truth is that women’s bodies are not studied enough, especially in the realms of reproductive health and female genitalia. Symptoms associated with menopause and menstruation have long been dismissed by doctors. Let’s not forget about the 19th and 20th century medical fascination with female hysteria, leading to women experiencing what was likely mental health issues being locked away from society. For far too long, research has been tainted by gender bias, with studies predominantly based on male participants and then applied onto women.

There is still much to learn about vaginismus and its physical and psychological impacts on women. In a country where mental health is considered a privilege reserved for a select few, many suffer in silence and shame.

Vaginismus is a lonely and terrifying condition. It isolates those who experience it, and when they seek help, they are often met with shame and silence. In a culture that confines women’s bodies to roles of enduring pain and delivering pleasure, it’s no surprise that we find ourselves burdened with trauma and unspoken emotions. These feelings accumulate in the hidden spaces between our hips, places shrouded in silence and misunderstanding, leaving us unsure of how to release them.

“I have been in clinical and physical therapy both,” says 31-year-old Qurat*. “Just a month ago, I managed to get a pap smear and felt invincible. But a week later, I couldn’t manage to get an internal ultrasound. I have seen people ‘cure’ themselves of vaginismus, but I guess everyone is on their own journey. Mine has had lots of ups and downs, but I just need to keep reminding myself that this doesn’t make me less of a woman or partner. If I am not kind to myself, no one else will be either.”

*Names have been changed to protect interviewees’ privacy

Courtesy: Dawn News
Aleezeh Fatima

Research shows menstruation is either delayed or occurs much earlier than expected in countries most vulnerable to climate change.

My sister got her first period at the tender age of seven and a half. Not prepared for the pain that comes with menstruation, the mental and physical exhaustion took the best of her. A year later, her period mysteriously stopped and never occurred again until the age of 12.

Menarche, the first menstrual period in a female adolescent, usually occurs between ages 10 and 16, with an average onset of 12.4 years. It often happens unexpectedly and is typically painless. However, the National Institute of Health (NIH) has recently found that menstruation is either delayed or occurs much earlier than expected in countries most vulnerable to climate change.

Pakistan is among the top-ranking countries that are bearing the brunt of this global crisis. Over the past 50 years, the country’s annual mean temperature has risen by about 0.5°C, with the number of heatwaves increasing nearly five-fold.

In May 2022, when temperatures across the country broke a 60-year record, 16-year-old Fariha Atiq — who started menstruating at the age of nine — witnessed possibly the worst period of her life.

“I was completely unequipped to deal with my period. Somehow I coped with it, but as time passed, the seasonal changes worsened my cramps. I remember in the summer of 2022, from April to August I couldn’t move my legs during my menstrual cycle,” she told Dawn.com.

Fariha’s mother, Mrs Atiq, took her to various gynaecologists but all of them described what the teenager was experiencing as ‘normal’, which was far from the pain she endured. Mild to moderate pain before and during menstruation is typical, but severe cramps can stem from various factors.

Mrs Atiq continued her search for a gynaecologist who could ascertain the reason for her daughter’s pain. Eventually, she found Dr Junaid Ansari, an obstetrics expert at Abbasi Shaheed Hospital, Karachi. He explained that the pain was caused by elevated levels of cortisol — a stress hormone influenced by temperature.

Cortisol increases with rising temperatures, contributing to dysmenorrhea, which nearly immobilised the teenager two years back.

Link between hormones and rising temperatures

For most women, menstruation is typically ‘painless’; some, however, experience severe cramps. This is a symptom of dysmenorrhea — pain during the menstrual cycle — and occurs due to the release of cortisol.

Cortisol is a hormone that is released during stressful situations and plays several roles in the female anatomy. It regulates blood sugar levels, metabolism, and blood pressure, and acts as an anti-inflammatory agent. Moreover, the hormone influences the menstrual cycle and prepares the body for pregnancy.

“The primary cause of a prolonged or delayed period can be the release of cortisol, which changes from season to season. For example, in winter, the release is higher, which disrupts the cycle,” Dr Ansari explained to Dawn.com.

The doctor highlighted, however, that he had observed the hormone peak during summers due to intense heat. “Very recently, I came across a 12-year-old girl with a decent body mass index, who wasn’t able to move due to extreme cramps, that too during May and July,” he shared.

“After recommending a cortisol blood test, we discovered that her cortisol level was 30 mcg/dL, significantly above the normal range of 14-20 mcg/dL for someone her age. We opted to monitor the levels and were surprised to find them returning to normal by the end of August following rainfall.

“While I continue my research, I am convinced that severe climate change is causing disruptions in menstrual cycles,” Dr Ansari added.

Extreme stress can disrupt the working of glands that control hormones such as cortisol and are responsible for the release of oestrogen needed for female reproductive characteristics.

Researchers at Poznan University of Medical Sciences in Poland have identified seasonal patterns in cortisol levels among female medical students. The study involved testing students twice in winter and twice in summer, with saliva samples collected every two hours over 24-hour periods to measure cortisol and inflammation markers.

Participants also completed lifestyle questionnaires detailing their sleep habits, diet, and physical activity levels. Unlike previous studies conducted in varied home environments, this research found higher cortisol levels during the summer sessions, while inflammation levels remained consistent across seasons. This further strengthens the argument that rising temperature has an impact on menstrual cycles.

(Un)common conditions

Contrary to popular opinion, dysmenorrhea is not a common condition.

“Most girls who come to me with cases of severe cramps are told by gynaecologists that cramps are normal, which is not true,” Dr Asifa Sofia of the Abbasi Shaheed Hospital told Dawn.com.

“This condition has developed in the last five years, and most patients I attend, the girls go through a painful period through winter,” she said.

Primary dysmenorrhea, the doctor explained, causes pain before and during menstruation. On the other hand, periods that become painful in the later stages could indicate secondary dysmenorrhea, which is often linked to conditions such as endometriosis or uterine fibroids that affect the uterus or pelvic organs.

“This usually occurs due to hormonal changes,” she highlighted, adding that painful periods and disruptions in blood flow were directly connected to erratic weather patterns in the region.

“I work with women from both urban and rural areas. One thing I have observed, which is a common pattern, is that with fluctuating temperatures, the sizes of follicles are affected, which in turn impacts the oestrogen levels,” Dr Sofia said.

The follicle is a small, fluid-filled sac in the ovary that contains one immature egg. Disruptions in size can alter hormones that regulate puberty, menstrual cycle, pregnancy, bone strength and other functions of the female body.

Sabiha, one of Dr Sofia’s patients from Thar, is being treated for an irregular period cycle. In May 2021, she started experiencing severe abdominal pain during menstruation. Like several other women, the 24-year-old initially brushed off the pain until one day, while working around the house, she fainted.

In Thar, May and June mark the hottest months of the year with temperatures reaching up to 122°F (50 °C).

“After that fall, my period has never been normal. I either bleed for 12 days straight or I don’t bleed at all. Irrespective of that, the pain stays the same,” she said. When asked if she had experienced such cramps before she began menstruating, Sabiha replied in the negative.

Sabiha is one such case. Dr Sofia told Dawn.com that she had treated patients after the 2022 floods whose period cycles took a hit from the massive disaster. “Today, even the slightest change in temperatures either alters their follicle size or their oestrogen levels which is alarming,” she pointed out.

Migration and displacement

“My period had always been regular until floods hit my town … suddenly, I started bleeding on random days,” Geetanjali, a resident of Balochistan’s Nasirabad district, recounted.

“I would not get periods for months, and then suddenly I would start bleeding out of nowhere,” said the 25-year-old. “Some days, the bleeding would be so bad and at other times it would just be a drop.”

These disruptions have taken a toll on Geetanjali’s physical health; she has lost 25 kilogrammes in the last three months.

Climate change triggers natural disasters, leading to mass migration which contributes to disturbance in the menstrual cycle. When Pakistan was hit by gigantic floods two years back, women went through brutal menstruation woes, the traces of which can be seen and felt even today.

Alongside poor menstrual hygiene, the affectees were also exposed to pollutants that affected the uterus. As per a systematic review published in the International Journal of Environmental Research and Public Health, pollutants affect the timing of menarche differently depending on the chemicals involved.

Studies have connected exposure to lead, polychlorinated biphenyls (PCBs), and flame retardants with delayed periods. Conversely, some toxicants such as endocrine-disrupting chemicals and the herbicide atrazine have been linked to early menarche.

PCBs were found in floodwaters heavily polluted with human and animal waste, impacting not only the onset of periods but also the shedding of the uterine lining, resulting in irregular menstrual cycles.

According to Geetanjali’s attending doctor Tahira Kashaf, the 25-year-old’s menstrual cycle had a lot to do with her sudden displacement and the stress that came with it.

“Her follicular size was affected by a high cortisol release and low oestrogen levels, leaving her body struggling with the heavy blood flow and cramps,” She said. “I’m concerned she might develop anaemia in a few days.”

The doctor added that a majority of female patients she had treated following the floods, particularly from Sindh and Balochistan, faced a similar problem.

“During a fertility cycle, when a follicle measures between 18 and 22 millimetres in diameter, it indicates rising oestrogen levels and thickening of the uterine lining. However, in the women who I treated post floods, the follicular size ranged between 9-12 millimetres, which indicated that oestrogen levels are extremely low,” Kashaf added.

Erratic patterns

In the past five years, Pakistan has experienced both intense heat and cold. Irregular periods aren’t limited to summer when temperatures rise rapidly, but can also occur in winters.

“I experienced intense cramps last year which made me scream, especially from the end of December to the middle of January,” said Arwa, 22. “I clocked my cycle and consulted a doctor, who asked me to get my melatonin checked.

“When I took the test towards the end of January, it was very low,” she recalled. Surprisingly, Arwa’s pain vanished by February, with regular menstruation cycles until April. But the pain returned in May, much more intense this time.

Aniqa Sajid, a mother of two, narrated going through a similar ordeal on the first and second days of her period.

“This is new to me because it has been happening for the last two years and it only happens during winters. Initially, it was just pain and I was able to move around, but with time … within six months it got so bad that even a couple of painkillers couldn’t help,” she said.

According to the NIH, the absence of natural sunlight during winter can disrupt serotonin and melatonin levels — which also play a part in regulating the menstrual cycle — in the body. This hormonal imbalance can lead to heavy periods. Additionally, when the temperatures decrease, blood vessels compress, leaving a narrower pathway for blood flow and contributing to heavier menstruation.

Dr Tahira Masood, a gynaecologist at the Liaquat National Hospital, also told Dawn.com that menstrual cramps can be intensified during winter.

“Dysmenorrhea is often caused by the secretion of hormone-like substances called prostaglandins. Cold weather can trigger an increase in these substances, leading to more painful cramps.

“The constriction of blood vessels in cold weather can exacerbate menstrual cramps. Many women report more severe cramps during winter, indicating that this is a common experience,” she explained.

Until a few years ago, menstruation was a taboo topic, hardly ever discussed in public. While this has improved over time, especially in urban areas, conversations on period pain and women’s health are still minimal.

As Pakistan scrambles to tackle the climate crisis, it is important to understand that this cannot be done without addressing gender equity, especially the underlying barriers that cause women to be disproportionately affected by natural disasters.

“Most women I come across have no clue that the changes they have been enduring in their menstrual cycles occur because of climate change,” Dr Tahira said, stressing the need for awareness.

She added that women’s health could not be compromised and in the long run, sustainable changes such as temperature-dependent tampons, hormonal medicines and other natural resources that keep the body running need to be normalised.

Aleezeh Fatimah is a pharmacist turned journalist.

Courtesy: Geo News

Intermittent fasting has numerous health benefits, including weight loss, better digestion and improved heart health

Intermittent fasting is an eating pattern where you don’t eat for a certain period and then eat during a specific set of hours. This can be done in a daily routine or even by fasting on alternate days.

Intermittent fasting has become popular due to its various benefits, such as prevention of heart diseases and weight loss.

Intermittent Fasting for Men:

There are several differences in intermittent fasting results for men vs women. E.g. in men, their metabolism increases by almost 14% during periods of fasting.

This comes in tandem with the fact that they also improve testosterone utilization, as well as growth hormone production.

Intermittent Fasting for Women:

For women, the result of intermittent fasting mainly puts the body in a state of fuel preservation mode, and according to many, provides fewer benefits.

This leads to a growing need to utilize a more modified approach.

Inversely it may cause changes in the female menstrual cycle, and may even affect the hypothalamus, during longer periods of fasting.

To better utilize the benefits of fasting, women should fast for shorter periods and have fewer fasting days in total.

Intermittent Fasting Benefits:

Here are 10 benefits of intermittent fasting backed by research;

1. Weight Loss Aid:

One benefit of intermittent fasting that most people want to avail of is weight loss. Intermittent fasting can lead to weight loss mainly by decreasing calorie intake, which happens due to consuming fewer meals.

Other ways intermittent fasting can help you lose weight is by lowering insulin levels and increasing the levels of norepinephrine, commonly known as noradrenaline.

By doing this, the body goes into a state of ketosis, and the subsequent fasting leads to a healthier metabolism as well as the breakdown of fats.

All in all, intermittent fasting is one of the most efficient ways to lose weight, backed by science.

2. Improved Insulin Metabolism:

Insulin is made by the pancreas, in response to increased blood sugar levels, and helps in bringing it down. In type 2 diabetes, patients’ cells can lose sensitivity to insulin, and abnormal blood sugar levels are noted.

Overall, intermittent fasting can help regulate blood sugar levels by reducing insulin resistance and by simply lowering calorie intake.

3. Prevents Chronic Inflammation:

Studies suggest that intermittent fasting can reduce inflammation in the body. For those unversed, inflammation is a natural defense mechanism of the body that allows white blood cells to be deployed to the injured site, for germ control.

But in cases when it goes array it leads to chronic inflammation which is the cause of many chronic diseases, including rheumatoid arthritis, high blood pressure heart disease, and inflammatory bowel disease.

4. Improves Cellular Health:

Intermittent fasting triggers cells to initiate repair processes, mainly autophagy. For those unversed, autophagy kills abnormal cells and recycles cellular materials in a highly efficient and programmed manner.

This can prevent diseases like cancer, which is a disease in which abnormal cells multiply unchecked.

One more benefit to cellular health is increased resistance to oxidative stress, which is when free radicals form in the body as a result of chemical reactions and bombard cellular organelles.

If this kind of damage occurs to important molecules like DNA, it can lead to several diseases including cancers and tumors.

5. Improves Heart Health:

When it comes to cardiovascular health, intermittent fasting can be a game changer. Intermittent fasting can improve various conditions that can become causes of heart disease.

These include abnormalities in blood sugar levels, blood pressure, and levels of high levels of LDL (bad cholesterol).

6. Prevents Neurodegenerative Diseases like Alzheimer’s:

Oxidative stress, high blood sugar, and inflammation can all lead to brain damage. By regulating all these factors, intermittent fasting benefits your brain’s health.

This leads to protection against neurodegenerative diseases like Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease.

7. Prevents Cancer:

While research in humans has led to inconclusive findings, intermittent fasting is thought to reduce the risk of cancer because it improves many health factors that are proven to be causes of cancer.

Overall, a reduction in inflammation, oxidative stress, and improvement in cellular health is known to lower the odds of cancer development.

8. Longevity:

Intermittent fasting has been found to improve the gut microbiome, which is the population of bacteria in your intestines.

A diverse population of good bacteria is considered important in maintaining overall health.

Intermittent fasting promotes the Christensenella species and is linked to longevity.

Note: Several researches have proven that intermittent fasting can delay disease, and improve metabolism.

9. Improved Digestion:

Intermittent fasting gives the digestive system a break, allowing it to rest and empty properly. This prevents the overgrowth of bacteria in the small intestine, where they aren’t supposed to be.

Proper emptying of the small intestine prevents digestive disorders like SIBO (small intestinal bacterial overgrowth), and IBS (irritable bowel syndrome).

10. Easy To Follow:

Intermittent fasting is a relatively simpler way of managing health. It avoids the over-complicated approach that many diets take and has numerous benefits for health.

All in all, for those looking for a more lifestyle-oriented shift, that can be maintained long-term, intermittent fasting is the best, noninvasive option available for weight loss.

1- Header image: Intermittent fasting has numerous health benefits, including weight loss, better digestion and improved heart health

Courtesy: Geo News

Add these super foods to your groceries to keep the winter depression at bay

The short and dark days of winter bring an air of melancholy, leaving everyone with little to no motivation to get out of bed.

To counter these effects and uplift moods, add these nutrient-dense foods and enjoy winters to the fullest.

1. Fish:

Fish is an essential source of Omega-3 fatty acids, responsible for the production of dopamine and serotonin (mood-enhancing hormones), and a healthy intake of fish will improve the brain’s emotional regulation. Additionally, tuna has Vitamin D that comes in handy when people live in places with low sun exposure, especially during winters.

2. Leafy Green Vegetables:

Popeye wasn’t pretending when he said spinach gave him strength. Leafy greens are packed with magnesium, calcium, and potassium to regulate stress and the sleep cycle, not to mention folate works alongside to reduce depressive symptoms.

3. Nuts:

Replace munch time with healthy nuts, to get a burst of Omega-3 Fatty acids and magnesium. Whether that be walnuts, almonds, or pecans because these nuts can accelerate the production of mood-enhancing neurotransmitters and offer positive mood-altering effects.

4. Fresh fruits and Berries:

Citrus fruits like lime and oranges can be a personal ‘Sun’ in winter, just as bananas are the granola bars of the fruit world.

Bananas are filled with vitamins, potassium, fiber, iron, protein, and carbohydrates. The same is true for berries as well because they are loaded with anti-oxidants to keep the mind fresh and happy.

5. Dark Chocolate:

A superfood that is often regarded as unhealthy, dark chocolates shower people with a load of feel-good compounds such as endorphins to improve mood.

Adding these nutrients to one’s diet can help tackle winter blues and boost energy as well as moods, from the inside out.

1- Header image: Top 5 nutritious foods to avert the winter blues and elevate mood