We have all celebrated the come back of Sunita Williams from the nine-month long ISS mission. But did you know that for the longest women astronauts were not sent into space or sent on more extended missions because of menstruation. However, it was not until Sally Ride, who became the first woman to menstruate in space became famous for her tampons.

This of course came with a set of challenges and figuring out on how many tampons would she need. Or how would she dispose them or the cost and weight of it. However, the big question is, how do women handle their period in space. How does menstruation work in microgravity?

Menstruation In Microgravity

While it is a common guess for many to think that in space, it becomes a retrograde menstruation, which means the blood flows back and could cause damage too. However, this is not the case. The female reproductive system is actually immune to the lack of gravity.

There are two options in how astronauts manage their period in space. They can either choose to delay period by taking pills or just deal with it as and when it comes.

There are waste-disposal facilities on board the international space station or the ISS that can handle human blood. However, it had not always been designed this way. Another challenge for women having their period is the added weight and the calculations of taking items like tampons and sanitary napkins.

The astronauts at NASA also undergo individual assessments tailored to their needs, mission duration and physiology. There are protocols too that allow for several choices, and individual treatment selected for any particular astronaut is a private matter between the astronaut and the flight surgeon.

However, the reality is that most women actually opt for contraceptives and put their periods on hold. This happens both during the preparation and during the spaceflight. However, no research has yet been done on long-term use of contraceptives in space. What we do know is that it can be consumed for long-term on earth.

Things Were Not Always That Easy

Like mentioned before, women were not sent on space missions thinking of retrograde menstruation. Furthermore, in 1964, researchers from the Women in Space Program suggested that putting "temperamental psychophysiologic human" which means hormonal women together with a "complicated machine" was a bad idea. While this was without any evidence, such biases have further hindered women and their achievement in the space.

However, it was the 1971 NASA report that pointed out that there may be place for women in space.

The Kanas and Fedderson's 1971 report went on to state: Information regarding women during periods of stress is scanty. This lack, plus previously mentioned problems will make it difficult for a woman to be a member of the first long-duration space missions. However, it is just as unlikely to think that women cannot adapt to space. Initial exploration parties are historically composed of men, for various cultural and social reasons. Once space exploration by men has been successfully accomplished, then women will follow. In preparation for this, more information should be compiled regarding the physiology and psychology of women under stressful situations.

Semaglutide, a well-known drug for diabetes and weight loss, commonly referred to as Ozempic, has been found to help patients with peripheral artery disease (PAD) walk longer distances. PAD is a circulatory condition where narrowed arteries reduce blood flow to the limbs due to plaque buildup. This condition is particularly common among individuals with diabetes.

A study published in The Lancet demonstrated that administering 1 mg of semaglutide to adults with type 2 diabetes and symptomatic PAD led to a 13% increase in their walking distance compared to those given a placebo. The drug was also associated with an improvement in ankle-brachial indices, a key test that compares blood pressure in the ankle to that in the arm, assessing blood flow in the lower limbs. The results of the STRIDE trial were presented at the American College of Cardiology Annual Meeting on March 29. The research was funded by Novo Nordisk, the manufacturer of Ozempic.

Beyond Blood Sugar Levels

The significance of this study lies in its demonstration of semaglutide's multifaceted protective effects beyond just improving blood sugar levels and aiding weight loss. Previous findings have already established its role in reducing the risk of cardiovascular events, benefiting kidney health, and even helping lower certain addictive behaviors.

Understanding Peripheral Artery Disease (PAD)PAD occurs when arteries narrow, restricting blood flow to the arms and legs. It is one of the most serious complications of diabetes and a leading cause of disability and amputation. More than 230 million people worldwide are affected by PAD, and there are currently no medical treatments available that can prevent or slow down its complications in diabetics.

Experts emphasize that PAD is a persistent and highly debilitating disease for which no current therapies exist. Patients suffering from PAD often experience severe limitations in their ability to function and walk without pain. As the condition progresses, some individuals may require interventions such as revascularization surgery, which aims to restore blood supply to the legs. In extreme cases, limb amputation may become necessary.

Semaglutide As A Potential Solution

Medical professionals point out that functional impairment in individuals with PAD is often overlooked in its early stages despite the severe disability it causes. The findings of the STRIDE trial are particularly promising as they indicate that semaglutide’s benefits on maximum walking distance were noticeable at 26 weeks and continued to improve up to 52 weeks without reaching a plateau. This suggests that semaglutide could be a viable long-term therapy option for PAD patients.

Experts further highlight that amputation is one of the most feared complications of diabetes and is significantly more common in diabetic individuals than in those without the condition. The findings of this study offer a ray of hope in addressing this pressing issue.

Following the trial’s promising results, Novo Nordisk has submitted a label extension application for Ozempic to the US Food and Drug Administration (FDA). If approved, this could mark a major breakthrough in the treatment of PAD, potentially offering a new medical option for millions affected by the disease.

As per the Australian Bureau of Statistics (ABS) National Health Measures Survey, 1 in 15 Australian adults is living with diabetes. The ABS also included the details on the number of Australians who showed signs of kidney disease, vitamin D deficiencies and other potential chronic illnesses.

The survey also noted a total 6.6% of Australians over the age of 18 have diabetes. There is also an increase of 1.5% when compared to a decade ago.

What Is Diabetes?

Diabetes is a long-term condition that happens when there is too much sugar in your bloodstream. This is because your body is unable to process it correctly. When someone is diabetes-free, the pancreas produce a hormone called insulin that helps move sugar into the cells of the body. However, with someone with diabetes, the pancreas either does not make enough insulin or the body does not use it well. This leads to sugar build up in the blood.

Increasing Prevalence of Diabetes

Diabetes has become a significant health challenge in Australia, with the number of diagnosed individuals rising to 1.3 million between 2000 and 2021. Data from the Australian Institute of Health and Welfare (AIHW) shows that men are more likely to have diabetes than women. Additionally, adults living in socioeconomically disadvantaged areas are at a higher risk of developing the condition. These figures highlight the growing burden of diabetes on individuals and healthcare systems nationwide.

Apart from diagnosed cases, an estimated 500,000 Australians may be living with undiagnosed type 2 diabetes. The National Health Measures Survey also found that 2.7% of adults are at high risk of developing diabetes. The prevalence of undiagnosed cases suggests a need for increased awareness, screening, and early intervention to prevent complications.

What Could Be The Risk Factors?

Several health risk factors contribute to diabetes, including a high body mass index (BMI), large waist circumference, smoking, and high blood pressure. Individuals with diabetes are more likely to exhibit multiple risk factors compared to those without the condition. However, data also shows that 88.9% of people with diabetes are non-smokers, and 70.5% maintain normal blood pressure levels. These findings align with the management goals set by the Royal Australian College of General Practitioners.

How Can Diabetes Be Managed?

Lifestyle and dietary changes can significantly reduce the risk of developing type 2 diabetes. Research indicates that up to 58% of cases can be delayed or prevented through healthier choices. However, approximately 42% of cases are linked to genetic factors, making prevention challenging for some individuals. Reducing the stigma around diabetes is essential to encourage at-risk individuals to seek medical advice and support without fear of judgment.

Cholesterol and Vitamin D Deficiency Trends

The AIHW health survey also examined cholesterol levels and vitamin D deficiencies among Australians. Around 30.2% of adults have high cholesterol, with women more likely to be affected than men. Additionally, 17.8% of adults have cholesterol levels close to abnormal.

High-density lipoprotein (HDL), often referred to as "good cholesterol," plays a crucial role in transporting cholesterol to the liver for breakdown. However, 14.9% of Australians have an abnormally low HDL level, increasing their risk of heart disease and stroke.

Seasonal Variations in Vitamin D Levels

Vitamin D deficiency is another widespread health concern, affecting 20.6% of adults. Seasonal variations impact deficiency rates, with 26.1% of adults experiencing low vitamin D levels in winter, compared to 15.5% in summer. Vitamin D is essential for calcium absorption, bone health, and muscle function, and severe deficiencies can lead to brittle bones and other health issues.

Pain is the body’s way of signaling that something is wrong. In most cases, pain fades once the underlying issue heals. However, for millions of people, pain becomes a constant companion, lasting for months or even years. This condition, known as chronic pain, not only affects physical health but also has a profound impact on emotional well-being.

Current studies emphasize the strong link between chronic pain and mental illness such as anxiety and depression. Individuals suffering from long-term pain tend to be stuck in a vicious cycle of fear, stress, and emotional distress. But how does chronic pain actually lead to deteriorating mental health, and how can the cycle be stopped?

For over 45 million Americans, chronic pain is a way of life. Although physical pain is the most visible symptom, its impact reaches far beyond the physical body. Chronic pain is frequently accompanied by psychological distress, as many victims experience anxiety and depression caused by their illness.

As per Dr. Ravi Kesari, a general medicine specialist, "Chronic pain and mental illness tend to exacerbate each other. Patients have disturbed sleep patterns, increased mental tension, and depression-like symptoms. This forms a vicious circle in which pain causes emotional distress, which further increases the perception of pain."

This cycle is especially seen in conditions like:

Fibromyalgia – A syndrome of widespread pain, fatigue, and cognitive difficulty.

Irritable Bowel Syndrome (IBS) – A bowel condition frequently associated with stress and tension.

Lower Back Pain – Prolonged pain in the lower back, often accompanied by decreased mobility and depression.

Migraine and Nerve Pain – Prolonged headaches and nerve pain that interfere with daily functioning.

Research indicates that two-thirds of IBS sufferers experience anxiety symptoms, and 65% of patients with depression exhibit chronic pain symptoms. This commonality indicates that mental illness not only heightens sensitivity to pain but also complicates recovery.

How Stress of Chronic Pain Can Rewires Your Brain?

When a person hurts, the body releases stress chemicals such as cortisol and adrenaline to assist in the regulation of pain. Such hormones are helpful during short-term occurrences, but once pain persists over time, continued exposure to stress hormones alters brain chemistry.

"Chronic pain leads to chronic stress, and that changes the neurochemicals in the brain that control mood, thought processes, and behavior," explains Dr. Kesari. "That's why people with chronic pain tend to be irritable, angry, or drained of emotions."

Chronic exposure to stress hormones can cause:

Heightened anxiety and fear reactions, making people excessively careful about everyday activities.

Depression, as serotonin and dopamine levels decrease—two neurotransmitters that produce happiness and motivation.

Cognitive impairment, including problems concentrating, remembering, or deciding.

Pain, Anxiety, and the Fear of Movement

Another very frequent mental impact of chronic pain is kinesiophobia, or fear of movement. Individuals with chronic pain tend to avoid movement for fear of making their pain worse. This avoidance behavior can cause stiffness in the muscles, loss of mobility, and increased pain over time.

For example, a person with chronic back pain might try to avoid exercising, which would further weaken muscles and worsen their condition. This pattern of avoidance and worsened pain begets a spiraling sense of helplessness that further fuels anxiety and mood shifts.

"Anxiety is an understandable reaction to chronic pain," says Dr. Kesari. "People become concerned about what pain will mean for their lives, so tasks that are minor—such as shopping for groceries or socializing—become overwhelming."

Daily Struggles and Self-Esteem Loss

Chronic pain does not only impact mood; it is able to significantly modify the way an individual perceives himself. Most of those who have chronic pain struggle with simple activities such as exiting bed, dressing up, or personal hygiene. Failing to do so by oneself may cause the individual to feel inadequate, frustrated, and socially withdrawn.

As Dr. Kesari describes, "Patients tend to feel ill at ease in social situations because they view their condition as a restriction. This adds to low self-esteem and exacerbates mental illness such as depression."

Considering the complex connection between chronic pain and mental well-being, both physical and emotional welfare must be treated.

Dr. Kesari stresses, "Healthcare providers need to take a whole-body approach to treating chronic pain. That involves coupling conventional pain management with mental health care to break the cycle between pain and emotional distress."

Some strategies that have been found to be effective are:

Cognitive Behavioral Therapy (CBT) – A type of psychotherapy that enables people to deal with negative thought processes and respond to pain.

Physical Therapy & Movement-Based Practices – Gentle exercise, like tai chi or yoga, decreases pain and alleviates fear of movement.

Medication Management – Painkillers can be beneficial, but only as part of a combination of holistic therapies to prevent dependency.

Stress-Reduction Techniques – Techniques such as meditation, deep breathing, and mindfulness assist in balancing stress hormones.

Social Support & Therapy Groups – Sharing experiences with others who live with chronic pain has been shown to combat the sense of isolation and offer emotional support.

Chronic pain is not merely a physical condition—it has a powerful impact on mental health, causing anxiety, depression, and extreme lifestyle constraints. But knowledge of the interlinkage of pain and emotional health can encourage proactive measures toward improved general well-being.

Dr Ravi Kesari is MBBS, MD- General Medicine at Apollo Spectra Hospital, Bangalore in India