As researchers have learned more about COVID-19 and its impact on the body, they have begun to recognize that the well-documented pulmonary effects of the virus are just the tip of the iceberg.
Increasingly, doctors and scientists are focused on how COVID-19 impacts the brain in big and small ways — none of them good. As one neuroscientist said in the journal Nature: “The neurological symptoms are only becoming more and more scary.”
Experts are still digging into the neurological impact of COVID-19, and there are perhaps more questions than answers at this point. But here are some of the biggest findings to date:
Neurological injuries from COVID-19 may actually be pretty common.
While the coronavirus-brain connection was once thought to be pretty rare, it now seems that may not be the case.
Research published in October by a team with New York University suggests that SARS-CoV-2, the virus that causes COVID-19, leads to neurological injuries in roughly 1 out of every 7 people infected.
Those injuries run the gamut in severity, from temporary confusion to seizures and stroke. And they can occur without the virus appearing to directly enter the brain or the nervous system, suggesting many neurological injuries associated with COVID-19 are a secondary effect of becoming really sick with the virus, which can lead to problems like oxygen loss and blood clots.
To that end, the researchers behind the NYU study have argued their findings show that doctors who treat patients with serious COVID-19 must be aggressive in getting oxygen levels stable. If they cannot, the brain may pay a steep price.
Severe effects, like inflammation of the brain, are possible.
Though rare, cases of encephalitis, or inflammation of the brain, have been documented among infected individuals. Experts say that’s not altogether surprising, given that encephalitis is often caused by viral infections. But it is serious, as encephalitis can be life-threatening.
It is not yet clear why certain people who have COVID-19 appear to develop this type of serious brain swelling.
But in a troubling development, it appears that some individuals develop encephalitis without demonstrating other more well-known symptoms. For example, in a case report that looked at roughly 40 people in the U.K. who developed neurological issues related to COVID-19, several patients who had encephalitis actually had pretty mild respiratory issues.
“This was the brain being hit as their main disease,” a neuroscientist behind the case study told the journal Nature.
COVID-19 has been linked to chronic cognitive deficits.
A preliminary study published in late October suggests that people who are infected with COVID-19 may have cognitive issues that last for months, particularly if they fall severely ill and require hospitalization.
By analyzing scores on a widely available cognitive test, researchers found that COVID-19 aged some patients’ brains by roughly 10 years.
“People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits,” the authors of the study wrote in a report of their findings.
One important note: The study was not subject to peer review. But it is not the only research to link ongoing cognitive decline with COVID-19, even in people considered to be recovered from the virus.
In a small study of 29 people in China who had COVID-19 and had recovered from the virus, the patients showed persistent issues with sustained attention, or the ability to focus on one task for a period of time without getting distracted.
COVID-19 symptoms can include neurological issues.
COVID-19 can certainly cause milder neurological symptoms, such as headaches and dizziness. The Centers for Disease Control and Prevention now includes headaches on its short list of some of the most common symptoms associated with the virus.
Some COVID-19 survivors may develop a mental health disorder.
Research also suggests that 1 in 5 patients might develop a mental illness for the first time within three months of getting infected with the virus. This could include anxiety, depression or insomnia.
At this point, it is unclear exactly what the link is, but experts have long known that physical and mental health are closely intertwined.
SARS-CoV-2 might enter the brain through the nose.
Again, doctors and researchers aren’t yet clear on how the coronavirus reaches the brain, but as experts with Johns Hopkins Medicine explain, they have generally zeroed in on four primary possibilities.
The virus may enter the brain directly and cause severe infection. The brain may be hurt when a person’s immune system goes into overdrive. The brain may be hurt by general chaos in the body (including low oxygen levels). Or the brain may suffer as a result of blood clotting.
That first possibility — that SARS-CoV-2 can cross into the central nervous system and brain — is among the most unsettling. But there is some new evidence suggesting it’s true.
A small German study of 33 people who died from COVID-19, published at the end of November in the journal Nature Neuroscience, found that more than half of the patients had evidence of SARS-CoV-2 in their noses and their brains, prompting researchers to conclude the virus could invade the nervous system — and the brain — through the olfactory tract. That might help explain why loss of smell and taste are a common symptom of COVID-19, although that is far from settled and a matter of ongoing debate among researchers.
While COVID-19 invading the brain through our noses might sound like the stuff of nightmares, there is still much research to be done in order for experts to truly understand how the virus affects the central nervous system. In the meantime, preventive measures continue to be essential. Wear masks, keep your distance and wash your hands.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
How Sleep Experts Get Through The Day When They’re Sleep-Deprived
If you’ve ever pulled an all-nighter or spent the night tossing and turning, you know how awful it can feel to be sleep-deprived.
Your body might ache, you may struggle to pay attention and your mood will most likely take a hit. This is because sleep is linked to nearly every important bodily function — it affects our immune system and our appetite, our stress hormones and our metabolism, our blood pressure and our cardiovascular system. Even a single night of poor sleep can trigger a wide range of health effects (which is why you may feel so crummy after that late night out).
Most of us need between seven and eight hours of sleep a night to feel alert and healthy the next day. But for whatever reason, that’s not always possible. In fact, a study recently published in JAMA Network Open found that nearly half of Americans are sleep-deprived on a regular basis.
The best way to combat sleep deprivation is ― well, to sleep. There’s really no quick fix, but there are a handful of tips and tricks that can make the day more bearable. We asked a few sleep specialists to share how they cope when they’re sleep-deprived. Here’s what they said.
Don’t stress about it
This is easier said than done, but it’s helpful not to get fixated on the fact that you’re sleep-deprived.
When Fiona Barwick, the director of the sleep and circadian health program at Stanford Health Care, is low on sleep, she reminds herself not to worry about it because she knows her body will do what it takes to get back on track.
Our sleep drive is a self-correcting system that naturally tries to keep the sleep-wake cycle in balance. “If we don’t sleep well one night, we’ll sleep better the next night. If we worry about it, however, our sleep will be worse,” Barwick said.
Expose yourself to light
Barwick also makes a point to expose herself to some bright light first thing in the morning. Our sleep-wake cycle is heavily dependent on light — daylight sends a signal to our brain that it’s time to get up and be active, while darkness sends the cue that it’s almost time to go to bed.
Exposing yourself to light when you first wake up “suppresses melatonin, which increases alertness and boosts mood,” Barwick said. It’ll also help keep your circadian rhythm in check, which should help you sleep more soundly at night.
Have some caffeine (but not too much)
It might seem obvious, but yes: Coffee helps. This is because caffeine blocks adenosine, a chemical in our body that increases the need for sleep. As a result, caffeine makes us feel less sleepy and improves learning and decision-making if you’re sleep-deprived, according to Dr. Andrey Zinchuk, a sleep medicine doctor with Yale Medicine.
But while it may be tempting to keep refilling your mug, it’s important to be mindful of how much caffeine you consume.
“I don’t have too much caffeine, as I want to avoid the crash that occurs when its alerting effects eventually subside,” Barwick said.
Dr. Wissam Chatila, a pulmonologist at Temple Lung Center and professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, advises against having that late-afternoon cup of coffee.
“If taken at the wrong time — e.g. late in evening — then they will interfere with sleep later on,” he said.
Take a catnap
If you’re able to squeeze in a 30- to 60-minute catnap, go for it. A short nap can improve alertness, sleepiness, memory and exercise capacity.
On the flip side, a lengthier midday snooze can actually impair cognitive function, Chatila said, and potentially make it even harder to complete tasks. Make sure to set an alarm so you don’t overdo it.
“I keep the nap relatively short so that I don’t use up too much sleep drive, as I want to save most of it for the coming night,” Barwick said.
If you’re not a napper, even getting some deep rest can be beneficial, Barwick said. Ten to 30 minutes of yoga nidra, a meditative yoga practice that involves deep relaxation, can help you feel refreshed and more attentive.
Go for a walk
Plus, it can build up your sleep drive, which should help you doze off at night.
“That helps to further ensure I will get better sleep the coming night,” Barwick said.
Know that your body is resilient
Lastly, don’t beat yourself up. Our bodies are incredibly resilient, which is why we’re still able to function even when we’re sleep-deprived. (Think about all you’ve been able to accomplish on those days when you didn’t get enough sleep.)
Don’t assume the day will be a wash just because you didn’t get the sleep you needed, Barwick said. Go easy on yourself, and listen to your body.
“I don’t cut back on what I planned to do, but I also don’t beat myself up if I get less done than I wanted,” she said.
Why Don't We Say 'ADD' Anymore?
5 Benefits Of Listening To Music While Working Out
Music is a lot of things: It’s restorative, motivational, moving and educational. There are endless ways we use music to get through our days, whether listening to a sad song on repeat or hitting play on an upbeat tune.
According to Ronna Kaplan, a clinical supervisor and adjunct music therapy faculty at Cleveland State University, “music is positive in many ways for mental health, it can be used across the lifespan” for many different situations.
One of those ways is during exercise. It can be a crucial element in enhancing your workout. Here’s how:
Your body’s movement naturally matches a song’s rhythm, which can help you stick to a specific pace.
There’s a reason your foot starts tapping or your shoulders start moving as soon as a song comes on. According to Joy Allen, the chair of music therapy and director of the music and health institute at Berklee College of Music in Boston, this is because of rhythmic entrainment, which is an “unconscious reaction — that’s what we call the entrainment.”
“Our body’s going to [move] in time with that sound or that rhythm,” she said.
So, when it comes to exercise, your body automatically falls in line with the tempo of the music “because of the way that our brains are connected with rhythm,” Allen said.
When picking music for a workout, like when going for a walk or run, for example, you’ll want to choose a tempo that is close to your natural stride. “Go [with] what seems comfortable for you and play around with different songs,” she said.
You can use music to increase your pace, too.
If you’re looking for an added challenge, pick a song with a pace that is a little quicker than your average running or walking stride, this should help you move faster throughout your workout.
You can start with a song with a slower tempo and gradually increase your speed by picking songs with faster beats, which is ideal if you’re looking to improve your walking or running pace, according to Kaplan.
“It primes the person to an outside cue,” she said. It “helps your muscles activate in their walking pattern.”
How often has someone walked into the gym, realized they forgot their headphones, and then had a not-so-great workout — or even left the gym altogether? Allen pointed out this is a common occurrence: There is a major reason why music is integral to so many people’s workouts.
The music you listen to during a workout helps with motivation, and there are several things behind that motivation.
First, you probably want to hear your favorite song on your exercise playlist, which may keep you going for longer. Second, if you put on music that’s unexpected (like if you put on reggaeton instead of your regular pop soundtrack), you will be interested in hearing what comes next in the song, which may also keep you moving longer than usual.
“If you’re always listening to the same stuff, sometimes that’s great [but] sometimes we have fatigue from it — we know what to expect and what’s coming, so it can be a little less motivating,” Allen said.
And music is distracting.
No one wants to focus on their tough workout as they’re in it. If anything, they want to not think about it. As you sing along to lyrics or are reminded of music-induced memories, songs let your mind wander throughout an exercise regimen, so you don’t have to stand (or sit) there and think about how hard your workout is.
Music keeps you from getting bored during a workout, too, which can happen when you’re doing something kind of mundane like walking on a treadmill, Allen noted. Music activates the brain by giving your mind something else to think about.
“It captures your attention… ‘oh, here’s something I’m listening to,’ so I’m not attending to what could be an uncomfortable experience with the exercise, it gives me something else to focus on,” Allen said.
You’ll reap even more benefits when you pick your music.
According to Kaplan, when someone chooses the music they’re listening to, they’ll have better results, whether working out or doing something like meditation.
A recent study led by the Department of Kinesiology at Samford University in Alabama stated, “if the music played over the speakers is not preferred by the individual giving effort, performance may suffer. Thus, coaches and athletes should consider individual music preferences when attempting to optimize performance and training.”
This further speaks to the motivation you feel when working out to music you enjoy.
Additionally, Kaplan said you might notice you’re in a better mood when working out to music you select, which may make you feel like you enjoyed your workout more. And that’s a win-win.
This may mean you’ll be more likely to work out again that week, which is a great way to hit your fitness goals.
6 Everyday Activities That Naturally Release Dopamine In Your Brain
Dopamine is a feel-good chemical that’s produced in your brain. Essentially, it makes you happy. And your brain releases it with certain activities and behaviors ― many of which you already do every single day.
“Whenever we participate in activities that are considered essential from our body’s point of view, our brain releases a large amount of dopamine,” which is meant to encourage you to do this activity more, according to Dr. Kiran F. Rajneesh, the director of the neurological pain division and associate professor of neurology at the Ohio State University Wexner Medical Center.
Throughout evolution, dopamine’s task was to “sense reward, learn the place and activity that leads to reward and also motivate you to go to those places to obtain [a] reward,” said Dr. Hitoshi Morikawa, an associate professor in the departments of neuroscience and psychiatry at the University of Texas at Austin. And that is still the case today. In essence, “dopamine is a reward sensor,” Morikawa said.
While this reward sensor was and is essential to human survival, evolution has made it so maladaptive behaviors also result in the release of dopamine in humans, both experts said.
“Generally, when neuroscientists talk about dopamine, we think about addiction because it is an addiction driver,” Morikawa explained.
The hormone makes you want to repeat certain behaviors, turning them into habits ― whether they are healthy or not. (Like substance misuse or smoking, for example.)
However, that’s not always the case. The release of this hormone is also part of your body’s daily function. While this is not a cure for any disease or condition, it can be helpful to know when dopamine is released — and when you can expect to feel a little mood boost as a result. Here are a few times when your body releases dopamine:
Our prehistoric ancestors knew that food was necessary for survival, in part because of the reward sensor that dopamine activated. This is still true today.
In fact, Rajneesh said that any activity that is “evolutionarily protective and essential for our well-being and survival” releases dopamine. Being able to find food and eat that food certainly falls into this category.
Some studies even say that eating results in a dopamine release twice: first when the food is eaten and again when the food is in the stomach.
Think about it: When you’re parched, a glass of water certainly feels like a reward, so it’s no wonder it also triggers the release of dopamine in your brain.
But not all sips of water will release dopamine, Morikawa noted. Instead, you have to really want or need the water — like after a tough workout or on a hot day.
“In the middle of summer in Austin, and you’re really thirsty, then drinking water should increase dopamine levels in the brain — that should be one of the most effective ways to increase them,” he said.
One really common way that dopamine is released is when praising children for good behaviors, Rajneesh said. Praise triggers a release of dopamine in kids’ brains — and the same goes for praising pets. In these situations, their good behaviors are reinforced by the feel-good nature of that dopamine release, he said.
The same is true when adults receive praise, Rajneesh added. So sending a congratulatory email to your colleague or a celebratory text to a friend is actually doing more good than you think.
This is especially important for people with certain conditions that are a result of low dopamine levels, like ADHD, according to ADDitude Magazine, an ADHD-focused publication.
Playing Video Games
Many studies have measured and found that playing video games results in the release of dopamine in the brain for some people, Morikawa noted.
While this in itself is not a bad thing, it can become negative if the feeling of playing video games is too positive or too fun, he added. When “elevating dopamine levels, sometimes you get really hooked [onto] certain activities,” Morikawa said.
In this case, that activity can be video games, which can lead to problems for people who aren’t professional gamers, he added. (For example, students who should be doing homework instead of playing.)
Sex causes a release of endorphins, as Dr. Elizabeth C. Gardner, an orthopedics sports medicine surgeon at Yale Medicine, previously told HuffPost. And studies show it also causes a release of dopamine.
During evolution, the dopaminergic system developed to promote the “survival and maintenance of our species,” Morikawa said. In other words, there’s an instinctual reason sex feels so enticing. Our brains are wired to know that sex is important for survival, and the neurons that release dopamine do so when they sense the reward associated with the act.
Activities That Enhance Your Well-Being
Meditating and other activities can also lead to a release of dopamine, Rajneesh said.
“Engaging in activities that enhance your well-being such as yoga, exercise, hobbies [and] games … can help release dopamine in the brain and further enhance your sense of well-being and health as nature intended it to be,” Rajneesh said.
‘Better Off Hibernating’: What It’s Really Like To Live With Seasonal Depression
While many of us may catch a case of the winter blues as the days get shorter, an estimated 10 million adults in the United States live with seasonal affective disorder.
This mental health condition, also known as seasonal depression, lasts around four to five months on average. “The appropriately named SAD, or seasonal affective disorder, is considered a type of depression characterized by its seasonal nature,” Jeff Temple, a professor at University of Texas Medical Branch and a licensed psychologist, told HuffPost.
Unsurprisingly, people living farther north in states with less sunlight and earlier sunsets are more likely to experience SAD, likely due to the lack of sunlight and much shorter days. However, that doesn’t mean people in warmer, sunnier climates aren’t affected. While seasonal depression is much more common during the winter months, some people may experience seasonal depression during summer or during the colder season because of the fewer daylight hours. Women experience it more frequently than men.
A common misconception is that SAD is less serious than major depressive disorder because it doesn’t last all year round. However, people with this mental health condition explained to HuffPost that the symptoms of SAD are very real, and can even be debilitating.
Here’s what they want you to know:
People with seasonal depression may struggle to do daily activities.
Like those with major depressive disorder, people with SAD may experience a lack of motivation and a loss of interest in day-to-day activities.
“I have had SAD for about 12 years, but I didn’t recognize the pattern or be diagnosed until about five years ago,” Claire, an optometrist, told HuffPost. (Claire, along with some others in this story, asked to keep her last name private so she could freely talk about her mental health condition.) “I am typically an early riser and consider myself a productive person. However, when SAD hits, I struggle to do even the smallest daily chores like doing the dishes or making dinner.”
Similarly, Rebecca, a grad student, said that she has a “difficult time keeping up with [her] self-care and workout routine during the winter months,” and finds it nearly impossible to “function at full capacity.”
People with SAD may also feel more isolated during the darker months.
Moreover, staying socially and emotionally connected to loved ones can require much more effort when coping with seasonal depression.
“The most prominent SAD symptoms I experience are loneliness and apathy. I tend to become quite numb in the winter months, and feel emotionally separated from the people around me,” said Vera, a freelance illustrator. “During regular depressive episodes, I may be able to ‘mask’ for most basic social interactions, whereas in winter seasons it’s not even an option. I’m too wiped out to even show up or pretend.”
Seasonal depression can interrupt normal sleep cycles and lead to extreme fatigue.
SAD and sleep disturbances go hand in hand. Chloé Perrin, a bartender, has found that her symptoms of seasonal depression often manifest as constant exhaustion, leading to hypersomnia. Simply put, hypersomnia is characterized by recurring episodes of sleepiness during the day, difficulty waking up in the morning, and feeling tired despite oversleeping.
“My family used to joke that every winter I’d hibernate, whereas my sleep is otherwise normal-to-low the rest of the year and during other episodes,” she said.
Bella Sutter, a dancer with seasonal depression, explained that “getting out of bed feels impossible and my mornings normally start late.”
“I feel as if I would be better off hibernating through the winter because seasonal depression makes me feel like I’m half asleep anyway,” she added.
People with seasonal depression may experience changes related to appetite and eating habits.
Not only does seasonal depression impact sleep, but this mental health condition can have a negative impact on a person’s eating habits. Researchers have found a marked correlation between SAD and higher rates of disordered eating, including behaviors such as binging, purging and restricting food intake.
For Anna Samanamú, a high school paraprofessional and graphic designer, symptoms of SAD began when she was a teenager. “My appetite becomes affected [with SAD], and I would prefer to sleep rather than eat,” she said. “Unfortunately, that led me to have issues such as anemia and Vitamin D deficiency.”
Seasonal depression may worsen symptoms of other mental health conditions.
According to Temple, “seasonal affective disorder has a bi-directional relationship with other mood disorders like depression and bipolar disorder — meaning that people with one form are much more likely to develop or worsen the other.” Notably, SAD affects up to 20% of people with major depressive disorder, and 25% of people with bipolar disorder.
Rhiannon Bellia, who works in social services, has found that seasonal depression tends to exacerbate symptoms of other mental health conditions.
“My OCD gets a lot worse in the winter, it’s harder for me to focus and gauge time with my ADHD. With having autism, it’s also a bit harder for me to regulate sensory overwhelm,” Bellia said.
There are treatments for SAD.
Temple explained that if symptoms such as losing interest in activities or feeling sad last “longer than a couple of weeks or [start] to interfere with your work, family, or relationships, then that’s a good sign that you may need some extra help.”
Fortunately, light therapy and cognitive behavioral therapy are proven to be effective treatments for people with SAD. The most beneficial at-home light therapy boxes provide light at 10,000 lux.
SAD is not simply feeling a little gloomy when the sun goes down; it is a serious mental health condition that can greatly impact every aspect of someone’s life.
“Please be kind to everyone who struggles with seasonal depression,” Samanamú said. “We are not lazy — sometimes there is just a disconnect from our minds and bodies. Many of us just need to take a little bit of time to become whole once again.”
The 6 Most Common Issues Introverts Bring Up In Therapy
As someone who spends a lot of time alone, I’d call myself an introvert. Not only do I enjoy my own company, but also I need that time alone to recharge myself even if it was just from a tiny social interaction. However, on the other hand, extroverts get energized by being around people and receiving lots of stimulation.
With that said, sometimes society isn’t made to fit the needs of introverts, and it can be difficult to socialize and communicate. That’s where therapy comes in handy: It can help you navigate these situations and assist you in exploring your own inner life, making you more comfortable with your quieter nature and your needs that come with it.
Below, we asked therapists to share the most common topics introverts frequently bring up in therapy and why they usually come up. If you relate, you’re not alone.
Finding space to recharge their social battery
Everyone needs a bit of alone time every now and then. However, some need it more than others ― and it can be hard to achieve that when loved ones may not understand how important it is or if you don’t have the physical space to just be isolated.
“Many introverts may feel drained after socializing with friends, and it’s important for them to create space to recharge. This can be difficult if they live with a partner or roommate,” said Kristen Casey, a telehealth clinical psychologist and insomnia specialist. “In therapy, we usually discuss how to communicate their needs effectively to ensure their friends or family understand that the creation of space from others is not personal.”
Kristen Gingrich, a therapist and certified alcohol and drug counselor, said that she usually tells her clients to go into a bathroom for five to seven minutes to ground themselves and recoup since it’s the place where you’re least likely to be bothered.
Setting boundaries with friends and loved ones
Many people find it difficult to set boundaries, but it can be even harder for introverts to speak up for themselves and communicate their needs.
“A lot of times, introverts talk about how they struggle to set boundaries because it can require more extroverted energy than they are comfortable with,” Gingrich said.
She added that when an introverted client is struggling with this, they may discuss ways to set boundaries that are clear and to the point, as sometimes it can be easy to get caught up in the discussion aspect as opposed to actually setting them.
Additionally, coping skills and distress tolerance skills are usually talked about because uncomfortable feelings and emotions will likely arise when setting boundaries, and it’s important for clients to know how to manage those in a healthy way when they come up.
Managing communication with friends
This isn’t a topic only introverts bring up in therapy, but it comes up often because it can be overwhelming to respond to texts and calls sometimes when your social battery is running low.
“The concept of answering phone calls or text messages may feel overwhelming for some introverts, and they may struggle with coaching their loved ones on their preferences for communication,” Casey said.
In these instances, the client might raise concerns around friends and family members taking their delay in response personally or viewing it as a sign that they don’t value the relationship, as opposed to it simply being a result of their needs.
“In therapy, we explore ways to coach friends and family on their preferences or how to answer briefly to maintain the relationship,” Casey said.
Managing overstimulation and irritability
After a while of socializing in a group setting, introverts will need that alone time to recharge their battery. When they can’t get that or have trouble communicating that need, it can sometimes lead to irritability ― a topic that introverts tend to bring up in therapy as they are looking for better ways to manage it.
“This is a thing I see with introverts and that is when they are overstimulated or their social battery runs empty, that they either shut down or it turns into irritability, which is really common,” Gingrich said.
In session, the therapist and client will together to discuss and build mindfulness skills and coping techniques to help prepare them for situations when they are highly irritable or overstimulated.
“We also talk about how to take accountability for the times where their irritability may get the best of them and come out towards other people,” Gingrich said.
Although it may be difficult, it’s important to take accountability and move forward in a more healthy and productive manner.
Wanting to find a romantic relationship
Dating is hard for just about anybody ― this includes introverts, who get easily drained by social interactions. Going on many dates can feel overwhelming for an introvert who needs frequent alone time to recharge.
“Clients often bring this up often because the idea of internet dating seems daunting with meeting lots of people and going out on different occasions,” said Heather Kent, a registered psychotherapist and trauma recovery specialist in Canada.
It’s not that introverts don’t want romantic relationships, but it can be hard to find the balance necessary to suit the needs of both people.
Dealing with societal pressure
Society places a lot of pressure on people to maintain the status quo in just about everything. However, introverts tend to find this hard when the extroverted personality is the default.
“Introverts often bring up how they worry about how others feel about them and that they feel a constant societal pressure to be involved in activities and engaged with friends,” Casey said. “They may also sometimes think that something is wrong with them, or that they aren’t living up to societal standards because of this.”
During sessions, she works with her clients to explore the need to adjust their own expectations with societal standards to ensure they feel seen and heard and live a life of their choosing. It’s more advantageous than trying to be someone you’re not.
What You Need To Know About Getting Pregnant With Polycystic Ovary Syndrome
Perhaps you already have a polycystic ovary syndrome (PCOS) diagnosis and a doctor has told you that you’ll likely have a hard time getting pregnant. Or maybe you’ve been trying to get pregnant for a while and are beginning to wonder if an underlying condition like PCOS is the reason it hasn’t happened yet.
PCOS is “a complex disorder that is very common — impacting [approximately] 10% of people with ovaries,” Dr. Lucky Sekhon, a reproductive endocrinologist and OB-GYN at Reproductive Medicine Associates of New York, told HuffPost.
“It is one of the most common causes of female infertility,” Dr. Christina Mitchell, an OB-GYN fertility specialist at the University of North Carolina School of Medicine, told HuffPost.
PCOS is a hormonal imbalance that prevents regular ovulation, but it manifests differently from one person to the next, and there are different criteria for diagnosis.
Sekhon explained that her clinic uses the Rotterdam criteria, meaning a person can be diagnosed with PCOS when they present with at least two of the three main symptoms: many cysts on the ovaries, which can hinder ovulation; irregular or absent periods; and/or signs of excess androgens, which are hormones like testosterone that can affect menstruation.
Obesity and insulin resistance ― a condition in which your body does not respond well to insulin, potentially leading to Type 2 diabetes ― are also common in people with PCOS. It is important to note, however, that not all obese people with ovaries have PCOS, and people who aren’t obese or overweight can develop PCOS, too.
Whether you’re trying to get pregnant or not, it’s important for a doctor to tailor a treatment plan to your individual needs.
How does PCOS affect fertility?
You can’t get pregnant without ovulating, or releasing an egg. If you’re not ovulating at all, pregnancy won’t happen without some intervention. If you’re ovulating irregularly, you might get pregnant, but it can be a challenge to figure out when you’re nearing ovulation in time for intercourse or insemination.
“PCOS results in few or no ovulatory events and thus infrequent opportunities to conceive,” Mitchell said.
In addition to a lack of cycle regularity making it difficult to know when ovulation will occur, “ovulation predictor kits can be less accurate in people with PCOS,” Sekhon said. “The ovulation predictor kits detect a rise in luteinizing hormone levels in the urine ― these levels tend to run high throughout the menstrual cycle in people with PCOS and can lead to confusing false-positive results that are all over the map.”
Infrequent ovulation means fewer attempts to conceive, explaining why many people with PCOS have a hard time getting pregnant. That said, you still can get pregnant even if your ovulation is irregular, and you should use birth control when you want to avoid a pregnancy.
What fertility treatments are available for people with PCOS?
The good news is that many people with PCOS are able to get pregnant with lifestyle modifications, medications or fertility treatments.
Some people improve their odds of pregnancy by losing weight — and the weight loss often doesn’t need to be huge. “Losing only about 5-10% of their body weight can restore normal ovulatory patterns, improving the chance of conception without any medical intervention,” Mitchell said.
However, a catch with this is that it’s often extremely challenging for people with PCOS to lose weight. The condition can sometimes even lead to weight gain.
Metformin, a Type 2 diabetes drug that sensitizes the body to insulin, can also be effective in regulating the menstrual cycles of people with PCOS.
In addition, there are drugs that induce ovulation. The two most commonly used are Clomid (clomiphene citrate) and Femara (letrozole). The medication is taken for five consecutive days at the beginning of your cycle, and then your doctor will do an ultrasound to see if your body is responding to treatment by preparing an egg for ovulation.
This ultrasound can also determine if the medication has worked too well. It’s important “to make sure you will not ovulate too many eggs if you have an overly robust response, which could increase the risk of twins,” Sekhon said.
Your doctor may also prescribe an injection of HCG (human chorionic gonadotropin — the hormone detected by pregnancy tests) to trigger your ovary to release the egg. This can help you more precisely time intercourse or insemination.
Injectable fertility medications, like the ones used in IVF cycles, can also be used to induce ovulation, “but this is now viewed as very aggressive, as it often leads to many follicles releasing eggs and leading to a higher risk of twins or triplets,” Sekhon said.
IVF offers the highest odds of success, although it is expensive and may not be fully covered by your insurance. It is also a more involved process, requiring many visits to the fertility clinic for monitoring via ultrasounds and blood tests.
What are my chances of success with these treatments?
“I tend to think of patients with PCOS as having a good prognosis, as irregular ovulation can most often be directly addressed with medication and lifestyle changes,” Sekhon said.
If weight loss, metformin, Clomid or Femara works and you ovulate, then you have the same chances of getting pregnant as any other ovulating person your age.
“Typically, for the average patient, we say there is approximately a 15% chance of conceiving with each ovulated egg,” Sekhon explained, adding that a person in their 20s has about a 20% chance of getting pregnant each cycle but that this drops to less than 5% for people over 40.
Injectable fertility drugs increase the number of eggs you ovulate, which in turn increases your odds of pregnancy — but also of having twins or higher-order multiples, which brings significant risks both to the pregnant person and the babies.
The likelihood of success with IVF depends both on your age and how many eggs you produce in response to the medications. People with PCOS often produce a high “egg count” on IVF drugs, leading to more chances for conception to occur.
Doctors can then fertilize all the mature eggs you produce to see which ones produce healthy embryos. An embryo that has been tested and proven to be genetically normal has a 50% to 70% chance of resulting in pregnancy. Doctors now generally transfer only one healthy embryo into the uterus at a time, virtually eliminating the risk of twins. If a cycle produces more than one healthy embryo, they can be frozen and thawed for later use.
That said, not every IVF cycle will produce any genetically normal embryos, and the odds of this outcome increase with age. Odds of success for fertility treatments are also lower if you or your partner has other fertility issues.
Why is it important to know that I have PCOS, even if I’m not trying to get pregnant?
If infertility is the symptom that brought you to your PCOS diagnosis, you may wonder why else it would matter. But PCOS affects more that just your reproductive system.
“Specifically, it increases the risk of metabolic disease, including high blood pressure, diabetes and high cholesterol — even in women who are not obese. Women with PCOS should have regular health screening for these conditions in order to prevent and/or treat them,” Mitchell said.
Because PCOS prevents the regular shedding of the uterine lining (aka your period), it can increase a person’s odds for pre-cancer or cancer of the uterus. There are treatments, such as birth control, to resolve this issue.
In addition, “many women with PCOS suffer from various bothersome symptoms, such as heavy or unpredictable vaginal bleeding, abnormal hair growth on their face or chin, and cystic acne. These can be treated very effectively with hormonal therapies, such as birth control pills, if the underlying cause is diagnosed,” Mitchell said.
And it isn’t just your physical health that matters, of course.
“Mental health issues — depression and anxiety — have been shown to be more common in women with PCOS,” Sekhon said. So it’s also important to be regularly screened for these, too.
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