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Does having irregular periods increase your risk of early death?

This blog was written by Rocío Martínez Aguilar (Post-doctoral Research Fellow) and Jacqueline Maybin (Senior Research Fellow and Consultant Gynaecologist). Both work at the MRC Centre for Reproductive Heath at the University of Edinburgh.

This month the media reported an increased risk of early death in women who have irregular periods, based on the findings from a recent study from Harvard University published in the British Medical Journal. This study is a very welcome addition to the medical literature, adding much needed data about menstruation and its impact on women’s lifelong health. However, media reports may also have caused distress for the millions of women experiencing irregular menstruation. In addition to the negative physical, social, mental and economic effects of having problematic periods, these women may now be worried that they are going to die earlier than those with trouble-free menses. The concern such headlines cause is exacerbated by the stigma and shame surrounding menstruation that prevents open, honest conversations. Here we explore the science behind the headlines and decode the language used regarding menstruation to give context to these findings.

What did this study do?

In this study, 79505 women were asked to report the regularity and frequency of their periods during three timepoints in their life: at 14 to 17 years old, 18 to 22 and 29 to 46. The frequency of menstruation is defined as the usual length of time from the first day of one period to the first day of the next period. Regularity is the amount of variation that occurs in this time from one period to the next. Women in the study described the regularity of their periods as either: very regular (occurring within 3-4 days of the expected date), regular (within 5-7 days), usually irregular, or always irregular/no periods. The frequency was categorised as 25 days or less, 26-31 days (considered ‘normal’), 32-39 days, or more than 40 days (too irregular to estimate).

The researchers then examined the number of premature deaths (that is, a death below the age of 70 years old) in each group and found this was greater in women with ‘always irregular/no periods’ than in women with ‘very regular’ menstruation. In addition, women with very infrequent periods ( more than 40 days/too irregular to estimate) had a small but statistically significant increased rate of premature death. This association remained when the data were corrected for factors such as BMI, physical activity or smoking. These relations were strongest for deaths due to cardiovascular disease (e.g. heart attack, stroke).

Other things to keep in mind

First, it is  is crucial to remember that irregular periods are a symptom (something you experience) rather than a diagnosis (something that causes the symptom). If irregular periods really did cause premature death, correction of the irregular menstruation should reverse the risk of dying early. The most common way of regulating menstruation is to take the oral contraceptive pill. However, in this study women who took the oral contraceptive pill during adolescence were actually more likely to have an early death. Therefore, it is possible that an underlying cause of irregular bleeding results in the increased risk of premature death, rather than having irregular periods, per se. We already know that women with polycystic ovarian syndrome (PCOS), a leading cause of irregular periods, have an increased risk of diabetes, high blood pressure and cancer of the womb. There are ways to reduce these risks and it is important that women with PCOS speak with their doctor. 

Second, in 2011 the International Federation of Gynaecology and Obstetrics (FIGO) first published guidance to standardise the language used for menstruation and introduce a classification system for abnormal periods. They recommended that doctors and scientists should assess menstrual duration, frequency, regularity, and volume. This study examined just two of these criteria but used a slightly different definition of regularity and frequency. This is likely to be due to the timing of data collection in this study, perhaps commencing prior to 2011. However, it is important to standardise such terms so that global data can be combined to find important conclusions regarding the impact of menstruation on health.

Lastly, the characteristics of the women who took part in this study were not representative of the diversity frequently seen in most societies, making it more difficult to apply the study findings to individual women seeking medical advice.  The majority  participants were white and they all worked as nurses. Some nurses work irregular hours, including nightshifts. This will have a significant impact on the natural body clock and previous studies have shown a link between shift work,  irregular periods and poor health. This was not accounted for in the study.

How well did the media cover the findings?

The study was covered in media outlets such as The Guardian, Daily Mail and CNN. Overall, the articles clearly described the key points of the study. The headlines summarised the most attractive findings but did not fall into the trap of confusing association with causation. The body of most articles clearly stated that there was an association between irregular periods and early deaths but explained that this does not mean that early deaths are caused by irregular periods. The importance of emphasising an association is not necessarily causal is an issue we have advised on within our Top Tips series at Research the Headlines. Most of the articles used quotes from independent experts alongside quotes from those who performed the study, an issue we have also previously highlighted. This provides a balanced overview and assessment of the research and highlights the positives of the study as well as the limitations that may otherwise go unnoticed by a non-scientifically trained audience.

The balanced reporting of these important findings highlights the benefits of good communication between scientists and the media. For researchers, engagement with the media facilitates an active role in public discourse about science, giving context to new discoveries, preventing sensationalism and limiting misconceptions. Perhaps it should be viewed as a moral duty for researchers to help society understand the latest scientific findings. Creating a media profile as a researcher is also an opportunity to inspire the next generation. As the saying goes, ‘if you can’t see it, you can’t be it’ and researchers who represent society in all its shapes and forms can, and will, have a significant positive impact on diversity and excellence in academia.

Conclusions

This study is a real step forward to close the huge data gap that exists regarding menstruation and its impact on lifelong health. As with all good research studies, it throws up many questions and areas of further study. It is imperative that we delineate how the menstrual cycle may affect, predict or be impacted by other diseases. Use of FIGOs standardised terminology and classification system will facilitate such research. After all, menstruation affects over 50% of the population and its relative invisibility in current scientific literature needs to be addressed. It is time to obtain good data on women and their menstrual cycles to improve their health across the lifespan.

Useful links

HOPE. Healthy Optimal Periods for Everyone.

Latest guidance on the language used for menstruation and the classification of causes for abnormal periods.


Does trauma lead to faster ageing in children?

This blog was written by Julie Cameron, Associate Director for Mental Health Foundation (Scotland and Northern Ireland).

Improving our understanding of how experiences of trauma and adversity in childhood impact on health outcomes as adults is of increasing interest and importance.  Trauma and adversity would include a wide range of factors including the experience of abuse, neglect, sudden death or abandonment, parental alcohol or drug misuse, parent being in jail, divorce, poverty, violence within the family unit and wider community. This sits within the broader context of the significant health inequalities in our society where people living in poverty are more likely to experience mental health problems, physical health problems, and die younger than those from more affluent backgrounds.

The role of adversity and trauma within this picture came to prominence following the US Adverse Childhood Experience (ACEs) survey which found that as the number of ACEs increased so did the risk of experiencing negative health conditions in adulthood.  This included mental health problems such as anxiety and depression, as well as physical health conditions like cardiovascular disease, diabetes, and cancer.  The relationship between mental health and physical health conditions is not fully understood.  Studies exploring this association have cited the impact of trauma on wider behavioural and relational factors, experiences of stigma, and discrimination, as well as neurobiological research on the impact of ‘toxic stress’ on brain development.  A recently published study provides further insight into the association between childhood trauma and later life experiences of poor physical and mental health.

What did this study do?

The study, led by Dr Katie McLaughlin at Harvard University, reported that children who suffer trauma from abuse or violence biologically age faster than children who have never experienced adversity. The study built on previous mixed findings on whether childhood adversity is linked to premature ageing.  The authors more clearly defined adversity into two categories (1) threat-related adversity of violence or abuse, and (2) deprivation related adversity of neglect and poverty. The study also used three signs of biological aging – early puberty, cellular aging, and changes in brain structures – to undertake a meta-analysis of almost 80 studies.  A meta-analysis is a systematic approach to the review of findings from multiple studies, which explore the same question or area of interest, to identify whether there are statistically significant common findings or conclusions that can be drawn. The study found that threat-related trauma was associated with all three signs of premature biological aging, but deprivation-related adversity was not significantly associated with premature aging.

How well does the media describe the study?

The study was covered in many media reports, including The Guardian and science news outlets.  Although the ‘science’ behind the association was reported in varying levels of detail what is interesting to note is the strong inequalities focus within the reporting.  This was clearly led by the author who highlights in her quotes the implications this study has for understanding health disparities and the need to focus prevention in the early years.  However, there are gaps in how these findings are presented.  Overall, there is a strong emotional detachment from the findings and little clarity into whether particular sub-groups are more or less impacted

This study provides evidence that exposure to violence makes children grow up faster, not only emotionally but biologically.  The severity of this situation within the articles is at times hidden behind terms such as trauma and adversity with little insight into the human cost.  There is no clarity within the reports as to whether particular sub-populations, particularly girls, are more or less impacted.  This is interesting as two of the media reports mention early onset of puberty in girls.  

The findings are also emphasised within a medical model, with little discussion on the implications of the findings on public mental health – the art and science of improving mental wellbeing and preventing mental health problems via organised efforts and informed choices of society, organisations, public and private, communities, and individuals. This is evident in the reporting of the lead author’s view of the findings. Quotes from Dr. McLaughlin frame implications of the study as the need to use existing evidence-based treatments to improve mental health in children experiencing trauma to slow down the pattern of accelerated biological aging.  There is no reporting into what this means from a public mental health perspective.  In particular,  for breaking cycles of violence and abuse so that fewer children and young people are exposed to these in the first place.  This would move the analysis and implications of the study from a very individualised approach to one that explores the policy and community supports required to create strong family units and thriving communities. 

Another important point to keep in mind is that the results of the meta-analysis were of a small effect, rendering them as potentially trivial. Even the authors themselves acknowledge that the findings are preliminary and so further research will be needed in the area before it can be stated that ‘Children who suffer violence or trauma age faster’. Additionally, the meta-analysis only focused on combining results from studies that have been published. Publishing non-significant findings (i.e. where results don’t show a strong relationship) can be more difficult to publish. As such, it cannot be ruled out that including unpublished scientific data could have changed the results.

Useful links:

www.cdc.gov/violenceprevention/aces

Adverse childhood experiences in context briefing paper (Aug 2019) Public Health Scotland: http://www.healthscotland.scot/population-groups/children/adverse-childhood-experiences-aces/overview-of-aces

Tackling Social Inequalities to reduce mental health problems: how everyone can flourish equally (Jan 2020) Mental Health Foundation: https://www.mentalhealth.org.uk/publications/tackling-social-inequalities-reduce-mental-health-problems

Do anxious mothers pass their stress on to their babies?

This post was co-authored by Margarita Kanevski and Sinead Rhodes.

Anxious mums can pass on their stress to their babies — leaving them with an ’emotional imprint’ that can scar them for life, scientists warn

In amidst of a global pandemic with many existing and expectant mothers already finding themselves in a heightened state of uncertainty, this recent headline by The Daily Mail would itself be more than enough to scar anyone for life. Upon a closer look, however, this attention-grabbing headline certainly calls for scrutiny in the context of the science behind it.

What did the actually study do?

The study was recently presented as an abstract at the European College of Neuropsychopharmacology congress. Researchers administered the famous Still Face Paradigm to 50 mothers and their three-month-old babies. During this paradigm mothers first interacted with their infant in a playful and engaging manner (playful phase) following which they were instructed to stare at their infant and remain still (stressful phase). The stressful phase, during which the mother acts distant, has been consistently shown to invoke signs of distress in children. Following the stressful phase, mothers were asked to resume engaging playfully with their child. To measure stress, researchers monitored heart rate activity of infants and their mothers throughout the task (where higher heart rates reflected increased stress levels). 

Mothers were interviewed using the Diagnostic Interview for Mental Disorders to assess if they met criteria for an affective disorder, also known as a psychiatric/mood disorder. In total, 20 of the mothers met criteria for one or more affective disorders and were included in the experimental group (a group with a condition of interest). The remaining 30 of the mothers did not meet criteria for an affective disorder and therefore formed the control group (a group without a condition of interest). Researchers compared the heart rates of infants and mothers across these two groups. Additionally, the researchers asked mothers to rate infants’ general temperament including things like smiling, laughter, fear, and distress.  

Results showed that babies of mothers with one or more affective disorders had higher heart rates during the stressful phase of the experiment, than babies in the control condition. The babies of mothers with an affective disorder were also rated by their mothers as being more negative in their general temperament. Importantly, researchers accounted for other important factors that could have been driving this difference between the groups, including maternal age at time of birth, income, and children’s birthweight. The authors concluded that babies with mothers suffering from an affective disorder struggle to deal with stressful situations.

How well did the media cover the findings?

The headline asserts that anxious mothers ‘pass’ on their stress to their babies. To infer that mothers ‘pass’ any traits to their offspring would require a complex examination of mother-child genetics which was not done in this specific study. Based on this, we cannot infer that mothers ‘pass’ on their stress to their infants. Notably, mothers in the control group (without an affective disorder) were found to have higher heart rates across all three phases of the study, which would actually suggest that these mothers were experiencing more stress during the experiment than mothers with affective disorders.

The headline also misleads the reader to infer that mothers were exclusively anxious. Rather, mothers were assessed using the Diagnostic Interview for Mental Disorders for affective disorders, which covers other debilitating conditions such as bipolar disorder and major depressive disorder. The study abstract did not provide a breakdown of which affective disorders mothers in the experimental group met criteria for the most. As such, asserting that findings relate to anxious mothers is misleading and is especially concerning given that postpartum anxiety or, in other words, excessive worry following giving birth, has been estimated to affect 13 to 40% of mothers, making it relatively common. The article goes on to state that having an anxious or depressed mother can scar children for life.  However, the study did not follow infants up over time and so no conclusions can be drawn regarding their well-being across the lifespan.

Other things to keep in mind

The first important point to consider is that the findings of the study are preliminary. This means that the work around the experiment is likely still ongoing and these are only the initial emerging findings. Indeed, the researchers themselves state that further work with a larger number of participants will be required before any final conclusions can be drawn.

Second, for findings of a study to be deemed as consequential and not occurring simply by chance, scientists typically rely on a statistical significance value (known as a p-value) being smaller than 0.05. If we look at the reported significance values for the group difference between the heart rates of infants across the two groups, these fall marginally just below this threshold (0.048 to be specific). This, coupled with the small sample size, challenges any conclusions that can be made based on the findings of this single study. Replication of this research, particularly by other independent research groups, is important before we can generalise the findings to mothers and infants in general.

Lastly, the study has not yet been peer-reviewed. It was presented at a conference and picked up by the media rather than being in a final peer reviewed publication. Peer review refers to the assessment of scientific work by other experts in the field and represents a critical aspect of validation of the quality of any research. Until this study is finalised and peer reviewed, we must be careful about interpreting its findings.

Useful links

https://www.nhs.uk/conditions/post-natal-depression/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/about-maternal-mental-health-problems/

Can beer really improve concentration and reduce the risk of dementia?

This blog is co-authored by Katie Nicol & Emilie Combet

Dementia and cognitive decline are growing concerns in today’s ageing society. Although we do not yet have the full picture of how cognitive decline initiates and progresses, it is thought that diet may be a risk factor. This opens an avenue of research testing foods and diet as a tool for cognitive decline prevention and possibly management. Previous blog posts have already investigated the science behind the superlative headlines linking food and drinks and brain health/dementia. Here, The Mirror, The Express and The Irish Post all capitalised on a finding from a recent study conducted in Japan, highlighting the potential positive effects of drinking beer and titled their article “Drinking beer could improve your concentration and reduce risk of dementia, study claims”. We will evaluate this claim by looking at the study and how it was reported by the newspapers.

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Can oral rinse mouthwash be another solution to protect you against COVID-19?

‘Never before, scientists say, have so many of the world’s researchers focused so urgently on a single topic. Nearly all other research has ground to a halt.’ The New York Times

Coronavirus disease (COVID-19) is an infectious and air-borne disease caused by a newly discovered coronavirus. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes.

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Can eating Tofu prevent heart disease?

Heart disease (Cardiovascular Diseases) have been the main reason of death over the past six decades. While in 1961 more than 50% of deaths in the UK were due to heart disease, this rate fell to 32% in 2009. However, heart disease is still the number one cause of death in the UK and globally (17.6 million deaths globally attributed to heart disease in 2016). This number is expected to grow to 23.6 million in 2030 (WHO, 2010) which means that although a lot of research has been done in this area, heart disease is still beyond our full understanding and a lot of research needs to be done in this area.

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Can a common parasite cause behavioural changes in humans?

Over the years the parasite Toxoplasma gondii has made the headlines on several occasions. It is considered one of the most successful parasites as it infects a wide range of birds and mammals, including humans, causing the disease Toxoplasmosis. It is estimated to infect approximately 30% of the world’s population, with some countries estimating up to 80% of infected population. It achieves part of its life cycle in the intestinal cells of cats, and when it infects other hosts, T. gondii can reside in their bodies for their life time where it can infect many other tissues, including the Central Nervous System and its major organ, the brain.

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School closures and coronavirus spread

This post was written by Emily McDougal and Sinead Rhodes.

The decision to close schools throughout the UK was a controversial issue with some arguing that it came too late, and others that it would put too much pressure on parents. By 18th March 2020, 107 countries had implemented such closures in response to the global pandemic.

A recent study considered the potential impact that closing schools has had upon the spread of Covid-19. Unsurprisingly it gained media attention, with coverage of the paper across many of the largest media channels. Here we explain the study and then look at reporting of the research by BBC News, The Guardian and Sky news to highlight the importance of transparent and clear reporting of research.

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Research Developments and COVID-19 in the UK

We are facing an unprecedented situation across the world with the COVID-19 pandemic. It is becoming very real for us in the U.K. In the last few days we have seen a significant rise in those ill with COVID-19 symptoms and deaths that are becoming substantial in number. Given the pattern of spread of the virus in Italy and other nearby European countries and the recent ‘lock-down’ of the UK it is easy to see why people are feeling panicked.

Let’s focus on something positive. Behind the scenes, in Universities across the UK, researchers specialising in infectious diseases are working around the clock not only to understand the virus by deciphering its genetic code, but to produce and test vaccines, and also how best to deliver treatments. Surprisingly there is relatively little media coverage of this work in light of the fact that every media outlet is almost solely covering COVID-19. Brexit and Scottish Independence seem almost forgotten. There is piece upon piece on the mass daily life disruption, movement of people, stock-piling and economic cost of COVID-19. These are all central worries to our daily lives of course, but it would be good to see more coverage of the science.

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Looking back at Research the Headlines in 2019

2019 was another challenging year for evidence-based media reporting of research. Research the Headlines was set up in 2013 to examine how research is portrayed in the media, and to give the public helpful advice and tools when trying to get to the heart of a news story.

During 2019 we again hosted a ‘brain blog’ series, showcasing the work of students who have been “researching the headlines” as part of their undergraduate studies. Their task was to describe an original research report exploring how lifestyle affects brain health in a manner accessible to non-experts, as well as evaluating the media coverage of the research. They wrote informative posts about alcohol and dementia risk and intellectual engagement and ageing. Through different activities, we also help others develop the skills needed to become more critical consumers of both research and media reporting; for example, via our How to “Research the Headlines” series and our “Rewrite the Headlines”workshops and competition for primary school children.

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