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The Gut-Skin Connection: Can Your Gut Health Affect Acne, Eczema, and Rosacea?

The Gut-Skin Connection: Can Your Gut Health Affect Acne, Eczema, and Rosacea?

Kadia Bielecki
If you've ever noticed that your skin seems to flare after periods of stress, illness, or changes in your diet, you're not imagining it. Researchers are increasingly exploring the gut-skin axis: the complex communication network between the digestive system, immune system, and skin. While gut health isn't the sole cause of skin conditions like acne, eczema, or rosacea, growing evidence suggests that the gut microbiome may influence inflammation, immune function, and skin health.¹ Here's what the science says about the connection. What Is the Gut-Skin Axis? Your gut is home to trillions of microorganisms collectively known as the gut microbiome. These bacteria, viruses, and fungi help digest food, produce beneficial compounds, regulate the immune system, and support the intestinal barrier.² Because approximately 70% of the body's immune cells reside within the gastrointestinal tract, changes in the gut microbiome can influence inflammation throughout the body, including the skin.³ This two-way relationship is known as the gut-skin axis. Can Poor Gut Health Cause Acne? Acne is a multifactorial condition influenced by hormones, genetics, inflammation, and the skin microbiome. However, researchers have also found differences in the gut microbiome of people with acne compared with those without.⁴ Some studies suggest that reduced microbial diversity and lower levels of beneficial bacteria may contribute to systemic inflammation, potentially influencing acne severity.⁴˒⁵ While improving gut health alone is unlikely to "cure" acne, maintaining a healthy microbiome may complement other evidence-based treatment approaches. What About Eczema? The relationship between the gut microbiome and eczema (atopic dermatitis) is among the best studied. Research suggests that individuals with eczema often have altered gut microbial diversity, particularly early in life.⁶ These changes may affect immune system development and inflammatory responses. Several systematic reviews have found that certain probiotic strains may modestly improve eczema symptoms in some individuals, although results vary depending on the strain, dose, and patient population.⁷ More research is needed before probiotics can be universally recommended as a treatment. Is There a Gut-Rosacea Connection? Rosacea is another condition where the gut-skin axis has received increasing attention. Studies have reported associations between rosacea and several gastrointestinal conditions, including inflammatory bowel disease, small intestinal bacterial overgrowth (SIBO), and Helicobacter pylori infection.⁸ While these associations do not prove that gut issues cause rosacea, they suggest that inflammation originating in the gut may contribute to disease activity in some individuals. How Does the Gut Influence the Skin? Scientists believe several mechanisms may explain the gut-skin connection: Regulation of immune function Production of anti-inflammatory compounds called short-chain fatty acids Maintenance of the intestinal barrier Communication between the gut microbiome and immune cells Effects on systemic inflammation²˒³ When the gut microbiome is well supported, these processes may help maintain healthy immune responses throughout the body. Foods That Support the Gut-Skin Axis While there is no single "skin diet," dietary patterns that support the gut microbiome may also benefit overall skin health. Eat More Fibre Dietary fibre feeds beneficial gut bacteria, allowing them to produce short-chain fatty acids that help maintain gut barrier integrity and regulate inflammation.⁹ Aim to include foods such as: Vegetables Fruits Legumes Whole grains Nuts and seeds Enjoy Antioxidant & Polyphenol-Rich Foods Polyphenols are plant compounds that beneficial gut bacteria can transform into bioactive molecules. Good sources include:¹⁰ Berries Green tea Olive oil Cocoa Colourful vegetables Include Omega-3-Rich Foods Omega-3 fatty acids have well-established anti-inflammatory properties and may help support both gut and skin health. Research suggests omega-3s can influence the composition of the gut microbiome while also helping regulate inflammatory pathways involved in several skin conditions.¹³ Good sources include: Salmon Sardines Mackerel Trout Walnuts Chia seeds Flaxseeds Include Fermented & Prebiotic Foods Fermented foods naturally contain live microorganisms that may help increase microbial diversity as part of a balanced diet.¹¹ Fermented foods include: Yogurt with live cultures Kefir Kimchi Sauerkraut Miso Don't forget prebiotics. Prebiotics are types of dietary fibre that feed beneficial gut bacteria, helping them grow and produce compounds that support gut barrier integrity and immune function. Pairing prebiotic-rich foods with fermented foods may provide complementary support for a healthy gut microbiome.¹¹ Good sources of prebiotics include: Garlic Onions Leeks Asparagus Jerusalem artichokes Green bananas Chicory root Oats Consider Probiotics Carefully Not all probiotics are the same. Research suggests that specific strains may support certain skin conditions, but benefits depend on the particular microorganism being studied.¹² Rather than choosing products based on marketing claims alone, it's best to discuss supplementation with a qualified healthcare professional. Foods to Limit While no single food causes skin conditions, dietary patterns high in ultra-processed foods may negatively affect the gut microbiome and promote inflammation. Consider limiting: Highly processed snack foods Sugar-sweetened beverages Excess added sugars Highly refined carbohydrates Foods high in artificial additives and emulsifiers These foods may reduce microbial diversity or alter the balance of beneficial bacteria over time. Instead, focus on a dietary pattern centered around whole, minimally processed foods rich in fibre, healthy fats, and plant compounds.¹⁴ The Bottom Line The gut-skin axis is an exciting area of research, but it's important to keep expectations realistic. Current evidence suggests that gut health may influence inflammation and immune function, both of which can affect skin conditions such as acne, eczema, and rosacea. However, the microbiome is only one piece of a much larger picture that also includes genetics, hormones, skincare, environment, and lifestyle. Supporting your gut through a fibre-rich diet, polyphenol-containing foods, fermented foods, quality sleep, stress management, and regular physical activity may benefit both your digestive health and overall wellbeing, with your skin potentially reflecting those healthy habits over time. References (AMA) Salem I, Ramser A, Isham N, Ghannoum MA. The gut microbiome as a major regulator of the gut-skin axis. Front Microbiol. 2018;9:1459. doi:10.3389/fmicb.2018.01459 Cryan JF, O'Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiol Rev. 2019;99(4):1877-2013. doi:10.1152/physrev.00018.2018 Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121-141. doi:10.1016/j.cell.2014.03.011 Deng Y, Wang H, Zhou J, Mou Y, Wang G, Xiong X. Patients with acne vulgaris have a distinct gut microbiota in comparison with healthy controls. Acta Derm Venereol. 2018;98(8):783-790. doi:10.2340/00015555-2968 O'Neill AM, Gallo RL. Host-microbiome interactions and recent progress into understanding the biology of acne vulgaris. Microbiome. 2018;6(1):177. doi:10.1186/s40168-018-0558-5 Lee SY, Lee E, Park YM, Hong SJ. Microbiome in the gut-skin axis in atopic dermatitis. Allergy Asthma Immunol Res. 2018;10(4):354-362. doi:10.4168/aair.2018.10.4.354 Huang R, Ning H, Shen M, Li J, Zhang J, Chen X. Probiotics for the treatment of atopic dermatitis in children: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2017;7:392. doi:10.3389/fcimb.2017.00392 Egeberg A, Weinstock LB, Thyssen EP, et al. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol. 2017;176(1):100-106. doi:10.1111/bjd.14930 Makki K, Deehan EC, Walter J, Bäckhed F. The impact of dietary fibre on gut microbiota in host health and disease. Cell Host Microbe. 2018;23(6):705-715. doi:10.1016/j.chom.2018.05.012 Del Rio D, Rodriguez-Mateos A, Spencer JPE, Tognolini M, Borges G, Crozier A. Dietary polyphenolics in human health. Antioxid Redox Signal. 2013;18(14):1818-1892. doi:10.1089/ars.2012.4581 Marco ML, Sanders ME, Gänzle M, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on fermented foods. Nat Rev Gastroenterol Hepatol. 2021;18(3):196-208. doi:10.1038/s41575-020-00390-5 Rather IA, Bajpai VK, Kumar S, et al. Probiotics and atopic dermatitis: an overview. Front Microbiol. 2016;7:507. doi:10.3389/fmicb.2016.00507 Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45(5):1105-1115. Zinöcker MK, Lindseth IA. The Western diet-microbiome-host interaction and its role in metabolic disease. Nutrients. 2018;10(3):365.
Aug 10, 2026
5 min read
Portugal Expanded Menstrual Leave in 2025. Here’s Why It Matters for Women Everywhere

Portugal Expanded Menstrual Leave in 2025. Here’s Why It Matters for Women Everywhere

Kadia Bielecki
For generations, people experiencing severe menstrual pain have often been expected to work through it quietly. In 2025, Portugal took an important step toward changing that expectation. Portugal introduced a legal right to paid menstrual leave for eligible workers with endometriosis or adenomyosis. The policy recognizes a reality that many people already understand: menstrual pain can sometimes be disabling, and treating it as a legitimate health issue is not the same as treating menstruation itself as an illness.¹ https://youtu.be/lfewWksL9Xw What Does Portugal’s Menstrual Leave Law Include? Portugal’s Law No. 32/2025 allows a worker experiencing severe, disabling menstrual pain caused by diagnosed endometriosis or adenomyosis to take up to three consecutive days of justified paid leave per month.¹ To qualify, the worker must provide their employer with medical documentation confirming the condition and associated disabling pain. This documentation does not need to be renewed every month.¹ The law took effect on April 26, 2025, and also created corresponding justified absences for students with these conditions.¹ Importantly, this is not a universal menstrual leave policy for anyone experiencing period pain. Eligibility is tied specifically to medically confirmed endometriosis or adenomyosis and severe, incapacitating symptoms. The Law Goes Beyond Time Off Work The legislation is broader than its menstrual leave provision. It also calls for measures intended to improve timely diagnosis and access to appropriate testing, specialist consultations, and treatment within Portugal’s public health system.¹ Additional provisions address medication coverage and fertility preservation, including access to egg cryopreservation for eligible patients.¹ This matters because endometriosis is a chronic condition that affects an estimated 5% to 10% of reproductive-aged women and is commonly associated with pelvic pain, painful periods, pain during intercourse, fatigue, and infertility.² Adenomyosis can also cause heavy bleeding, severe cramping, chronic pelvic pain, and significant disruption to daily life.³ Why Menstrual Pain Is a Workplace Issue Severe menstrual symptoms do not stop when the workday begins. Research involving women with endometriosis across 10 countries found that the condition substantially affected both quality of life and work productivity. Much of the productivity loss occurred through presenteeism, meaning employees continued working but were less able to perform effectively because of pain and other symptoms.⁴ A large study of nearly 33,000 women examining menstrual symptoms more broadly found that presenteeism accounted for considerably more lost productivity than absenteeism. Many participants reported working while experiencing symptoms but functioning below their usual capacity.⁵ More recent population-based evidence also indicates that women with endometriosis experience more sick days, reduced work ability, lower productivity, and more working years lost than women without the condition.⁶ These findings suggest that the choice is not simply between working and staying home. Without appropriate support, many people may remain at work while experiencing pain, fatigue, heavy bleeding, nausea, bowel symptoms, or difficulty concentrating. Could Menstrual Leave Reduce Stigma? A policy that formally recognizes disabling menstrual pain may help validate symptoms that have historically been minimized or dismissed. It can also encourage more open conversations about endometriosis, adenomyosis, and menstrual health. When employers understand that severe period pain may signal an underlying medical condition, employees may feel more comfortable seeking care instead of assuming they must simply tolerate it. However, policy alone cannot eliminate menstrual stigma. Research on menstrual health policy warns that poorly designed programs may unintentionally reinforce the belief that menstruating employees are less capable or dependable.⁷ Some workers may also hesitate to disclose a diagnosis to their employer because of privacy concerns, fear of judgment, or worries about career consequences. What Are the Limitations? Portugal’s policy represents progress, but it does not support everyone living with debilitating menstrual pain. Because leave requires a confirmed diagnosis, people who are still navigating lengthy diagnostic pathways may not qualify. This is especially important for endometriosis, which is frequently diagnosed only after years of symptoms and repeated healthcare visits.² The policy also focuses on leave rather than the full range of workplace accommodations that may help employees remain engaged when they are able to work. Depending on the individual, useful supports may include: Flexible or remote work Adjusted start times Additional breaks Access to washrooms and private spaces Heat therapy Reduced physical duties during symptom flares Supportive and informed management Menstrual leave should therefore be viewed as one option within a broader workplace health strategy, not as a substitute for timely diagnosis, treatment, flexibility, or respectful workplace culture. What Does This Mean for Other Countries? Portugal is part of a growing international conversation about menstrual health at work. Spain introduced a national menstrual leave framework in 2023, while menstrual leave policies have existed in countries including Japan, South Korea, Indonesia, Taiwan, and Zambia in different forms.⁸ Whether other countries adopt Portugal’s model remains uncertain. Still, the law raises an important question: should someone with severe, medically documented menstrual pain have to choose between their health, their income, and their employment? The Bottom Line Portugal’s 2025 menstrual leave law does not suggest that every period requires time away from work. It recognizes that endometriosis and adenomyosis can produce severe, disabling symptoms that deserve appropriate medical and workplace support. Real progress will require more than leave alone. It will also require earlier diagnosis, accessible treatment, flexible workplaces, privacy protections, and a culture in which menstrual pain is taken seriously. For women and people who menstruate everywhere, Portugal’s decision sends a powerful message: working through disabling pain should not be considered the price of participating in public, academic, or professional life. References Portugal. Lei n.º 32/2025, de 27 de março: promoção dos direitos das pessoas com endometriose ou com adenomiose. Diário da República. Published March 27, 2025. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. doi:10.1056/NEJMra1810764 Upson K, Missmer SA. Epidemiology of adenomyosis. Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718921 Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. doi:10.1016/j.fertnstert.2011.05.090 Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32,748 women. BMJ Open. 2019;9(6):e026186. doi:10.1136/bmjopen-2018-026186 Røssell EL, Plana-Ripoll O, Josiasen M, et al. Association between endometriosis and working life among Danish women. Hum Reprod. 2025;40(3):461-468. doi:10.1093/humrep/deae298 Johnston-Robledo I, Chrisler JC. The menstrual mark: menstruation as social stigma. Sex Roles. 2013;68(1-2):9-18. doi:10.1007/s11199-011-0052-z Levitt RB, Barnack-Tavlaris JL. Addressing menstruation in the workplace: the menstrual leave debate. In: Bobel C, Winkler IT, Fahs B, Hasson KA, Kissling EA, Roberts TA, eds. The Palgrave Handbook of Critical Menstruation Studies. Palgrave Macmillan; 2020:561-575. doi:10.1007/978-981-15-0614-7_43
Aug 07, 2026
5 min read
Does "Cortisol Face" Actually Exist? Here's What the Science Says About Stress and Facial Puffiness

Does "Cortisol Face" Actually Exist? Here's What the Science Says About Stress and Facial Puffiness

Kadia Bielecki
If you've spent any time on TikTok or Instagram lately, you've probably come across the term "cortisol face." It's often used to describe a puffy, swollen, or round-looking face that influencers claim is caused by chronic stress and elevated cortisol levels. But is cortisol face a real medical condition? The short answer is not exactly. While chronically elevated cortisol can affect the body in certain medical conditions, there's little evidence that everyday stress alone causes the dramatic facial changes often portrayed on social media.¹ Let's look at what the science actually says. What Is Cortisol? Cortisol is often called the body's "stress hormone," but it does much more than respond to stress. Produced by the adrenal glands, cortisol helps regulate: Blood sugar Blood pressure Immune function Inflammation Metabolism Sleep-wake cycles¹ Your body naturally releases cortisol throughout the day, with levels typically highest in the morning and gradually declining toward bedtime. This daily rhythm is essential for healthy energy and overall well-being.² Is "Cortisol Face" a Real Diagnosis? No. "Cortisol face" is not a recognized medical diagnosis, and there are currently no studies demonstrating that everyday psychological stress alone causes the facial puffiness commonly promoted online. However, persistently elevated cortisol due to Cushing syndrome or long-term corticosteroid medication can cause a characteristic rounded appearance known as "moon face." This occurs because prolonged exposure to excessive cortisol changes how fat is distributed throughout the body.³ Importantly, this is very different from the temporary effects of everyday stress. Can Stress Make Your Face Look Puffy? Possibly, but not necessarily because cortisol is directly changing your face. Periods of chronic stress often coincide with habits that may contribute to temporary facial puffiness, including: Poor sleep Increased sodium intake Alcohol consumption Dehydration Reduced physical activity Hormonal fluctuations⁴ Stress may also promote low-grade inflammation and fluid retention in some individuals, although the relationship is complex and influenced by many factors beyond cortisol alone.⁵ In other words, if your face looks puffier during stressful periods, cortisol may be one piece of a much larger picture. What Are the Signs of Chronically High Cortisol? While everyday stress causes temporary increases in cortisol, true cortisol excess is uncommon and usually results from an underlying medical condition. Symptoms of persistently elevated cortisol may include:³ Rapid weight gain, particularly around the abdomen Rounded "moon" face Easy bruising Purple stretch marks Muscle weakness High blood pressure Elevated blood sugar Irregular menstrual cycles If these symptoms develop, they should be evaluated by a healthcare professional rather than self-diagnosed through social media. How Can You Support Healthy Cortisol Levels? Rather than trying to "eliminate cortisol," the goal is to support your body's natural stress response. Research consistently supports several lifestyle strategies: Prioritize Sleep Sleep deprivation disrupts normal cortisol rhythms and may increase perceived stress. Aim for 7-9 hours of quality sleep each night whenever possible.⁶ Eat Balanced Meals Large swings in blood sugar can place additional stress on the body. Eating balanced meals that include protein, fibre, and healthy fats may help support steady energy throughout the day.⁷ Exercise Regularly Moderate physical activity helps improve resilience to stress over time, although excessive training without adequate recovery may temporarily increase cortisol.⁸ Manage Chronic Stress Mindfulness, yoga, breathing exercises, spending time outdoors, and strong social connections have all been shown to support healthy stress regulation.⁹ Consider Nutritional Support Emerging research suggests that certain nutrients, including magnesium, play important roles in stress physiology, particularly in individuals with inadequate dietary intake.¹⁰ Some adaptogenic herbs have also been studied for stress support, but evidence varies depending on the ingredient and product. More high-quality research is still needed before firm conclusions can be made.¹¹ The Bottom Line "Cortisol face" has become a popular social media term, but it's not a recognized medical diagnosis. While severe cortisol excess caused by conditions like Cushing syndrome can lead to noticeable facial changes, everyday stress is unlikely to dramatically alter your appearance on its own. More often, facial puffiness reflects a combination of sleep, hydration, nutrition, inflammation, hormones, and lifestyle habits. If you're concerned about persistent swelling, unexplained weight changes, or symptoms of chronically elevated cortisol, speak with your healthcare provider for a proper evaluation. Instead of chasing viral trends, focus on evidence-based habits that support your overall health and help your body respond to stress in a healthy, sustainable way. References (AMA) Nicolaides NC, Kyratzi E, Lamprokostopoulou A, Chrousos GP, Charmandari E. Stress, the stress system and the role of glucocorticoids. Neuroimmunomodulation. 2015;22(1-2):6-19. doi:10.1159/000362736 Nader N, Chrousos GP, Kino T. Interactions of the circadian CLOCK system and the HPA axis. Trends Endocrinol Metab. 2010;21(5):277-286. doi:10.1016/j.tem.2009.12.011 Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 Palmer BF, Clegg DJ. Physiology and pathophysiology of sodium retention in edema states. Mayo Clin Proc. 2016;91(10):1453-1461. doi:10.1016/j.mayocp.2016.06.007 Black PH, Garbutt LD. Stress, inflammation and cardiovascular disease. J Psychosom Res. 2002;52(1):1-23. doi:10.1016/S0022-3999(01)00302-6 Leproult R, Van Cauter E. Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev. 2010;17:11-21. doi:10.1159/000262524 Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287(18):2414-2423. doi:10.1001/jama.287.18.2414 Hackney AC. Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Expert Rev Endocrinol Metab. 2006;1(6):783-792. doi:10.1586/17446651.1.6.783 Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152-168. doi:10.1016/j.psyneuen.2017.08.008 Boyle NB, Lawton C, Dye L. The effects of magnesium supplementation on subjective anxiety and stress: a systematic review. Nutrients. 2017;9(5):429. doi:10.3390/nu9050429 Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress-protective activity. Pharmaceuticals (Basel). 2010;3(1):188-224. doi:10.3390/ph3010188
Aug 05, 2026
4 min read
A New Way of Diagnosing Endometriosis?

A New Way of Diagnosing Endometriosis?

Kadia Bielecki
For years, endometriosis has been one of the most underdiagnosed and misunderstood conditions affecting women and people assigned female at birth. Characterized by symptoms such as chronic pelvic pain, painful periods, pain during intercourse, bowel or bladder symptoms, and infertility, endometriosis has historically been associated with significant delays in diagnosis. Although awareness has improved, many people still wait an average of 7 to 10 years before receiving a diagnosis.¹˒² Fortunately, advances in imaging are changing the way endometriosis is diagnosed. Today, transvaginal ultrasound (TVUS) with endometriosis mapping has emerged as a valuable, non-invasive tool that can identify many forms of endometriosis without requiring surgery.³ What Is Endometriosis Mapping? Endometriosis mapping is an advanced transvaginal ultrasound performed by clinicians with specialized training in identifying the characteristic features of endometriosis. Unlike a routine pelvic ultrasound, which may miss many endometriosis lesions, this specialized examination systematically evaluates the pelvis for signs of:³˒⁴ Deep infiltrating endometriosis (DIE) Endometriomas (ovarian endometriosis cysts) Pelvic adhesions Distortion of normal pelvic anatomy Reduced organ mobility, including the "sliding sign" Most specialists follow the standardized International Deep Endometriosis Analysis (IDEA) protocol, which was developed to improve consistency and diagnostic accuracy across imaging centres.⁴ How Accurate Is It? Research over the past decade has shown that expert-performed TVUS is highly accurate for detecting deep infiltrating endometriosis and ovarian endometriomas.⁵ A large systematic review found that TVUS demonstrates high sensitivity and specificity for many deep endometriosis locations, particularly involving the rectosigmoid bowel, bladder, and rectovaginal septum when performed by experienced operators.⁵ However, TVUS remains less sensitive for superficial peritoneal endometriosis, meaning a normal ultrasound does not completely exclude the condition.³˒⁵ Clinical symptoms and physical examination remain important parts of the diagnostic process. Why This Matters Historically, laparoscopic surgery was considered the definitive way to diagnose endometriosis. However, international clinical guidelines have evolved. Current recommendations from the European Society of Human Reproduction and Embryology (ESHRE) support using transvaginal ultrasound or MRI as first-line diagnostic imaging in patients with suspected endometriosis. Imaging findings, together with symptoms and clinical evaluation, can often provide enough information to begin treatment without requiring immediate surgery.³ This represents an important shift in care. Earlier diagnosis may help reduce years of uncertainty, allow patients to begin symptom management sooner, improve surgical planning when needed, and reduce unnecessary diagnostic procedures.¹˒³ What Should You Ask Your Healthcare Provider? Because endometriosis mapping requires additional training, not every ultrasound clinic performs this examination. If you're seeking evaluation for possible endometriosis, consider asking: Do you perform transvaginal ultrasound using the IDEA endometriosis mapping protocol? Does the sonographer have experience evaluating deep infiltrating endometriosis? Would MRI be appropriate if my ultrasound is inconclusive? How will the imaging results influence my treatment plan? The Bottom Line Endometriosis mapping with transvaginal ultrasound is changing how clinicians diagnose endometriosis. While it does not detect every form of the disease and does not completely replace surgery in every case, it has become an important first-line diagnostic tool supported by current international guidelines.³ For many people living with chronic pelvic pain or other symptoms of endometriosis, access to expert imaging may mean receiving answers sooner, reducing unnecessary delays, and helping guide more personalized treatment decisions. References (AMA) Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. doi:10.1056/NEJMra1810764 Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852. doi:10.1016/S0140-6736(21)00389-5 Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Updated recommendations remain current through the 2025 ESHRE guideline update. doi:10.1093/hropen/hoac009 Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including the IDEA consensus. Ultrasound Obstet Gynecol. 2016;48(3):318-332. doi:10.1002/uog.15955 Nisenblat V, Bossuyt PM, Farquhar C, et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2:CD009591. Updated evidence continues to support expert TVUS as the preferred first-line imaging modality for deep endometriosis. doi:10.1002/14651858.CD009591.pub2
Aug 04, 2026
3 min read
The Hidden Nutrient Deficiencies Women Should Know About

The Hidden Nutrient Deficiencies Women Should Know About

Kadia Bielecki
If you've ever been told that your blood work is "normal" but you still feel exhausted, you're not alone. Fatigue is one of the most common reasons women seek medical care, yet standard blood tests don't always identify every possible contributor. While poor sleep, stress, thyroid disorders, and underlying medical conditions should always be considered, subtle nutrient deficiencies or insufficiencies may also play a role in persistent low energy.¹ Here's what you should know if you're wondering why you're tired all the time despite "normal" test results. Could Your Iron Stores Be Low Even Without Anemia? Iron deficiency doesn't always progress to anemia. Many women have low iron stores (low ferritin) while maintaining a normal hemoglobin level. Because routine blood work often focuses on hemoglobin, low iron stores can sometimes be overlooked if ferritin isn't evaluated. Low ferritin has been associated with fatigue, reduced exercise tolerance, impaired concentration, and decreased quality of life, even in women without anemia. Several randomized controlled trials have shown that iron supplementation may improve fatigue in women with low ferritin and otherwise normal blood counts.²˒³ Women with heavy menstrual periods, restrictive diets, endurance training, or pregnancy are at higher risk for iron deficiency. Vitamin B12: More Than Just a Vitamin for Vegetarians Vitamin B12 plays a critical role in red blood cell production, nerve function, and energy metabolism. Inadequate intake or poor absorption can contribute to fatigue, weakness, numbness or tingling, and difficulty concentrating.⁴ People at greater risk include those following vegetarian or vegan diets, older adults, individuals taking long-term acid-reducing medications, and people with gastrointestinal conditions that affect nutrient absorption.⁴ Although severe deficiency is usually detected through blood testing, borderline levels may still warrant further evaluation when symptoms are present. Don't Overlook Folate Folate works closely with vitamin B12 to support healthy red blood cell formation and DNA synthesis. Inadequate folate intake may contribute to fatigue, particularly when combined with low vitamin B12 or iron status.⁵ Good dietary sources include leafy greens, legumes, asparagus, citrus fruits, and fortified grains. Vitamin D May Influence Energy, Mood, and Muscle Function Vitamin D is well known for supporting bone health, but it also plays important roles in immune function, muscle health, and overall wellbeing. Low vitamin D status has been associated with fatigue in several studies, although research suggests that supplementation is most beneficial when a true deficiency is present.⁶ Women living in northern climates, spending little time outdoors, or consistently using sun protection may have an increased risk of deficiency. Magnesium: The Often Forgotten Mineral Magnesium is involved in more than 300 enzymatic reactions throughout the body, including energy production, muscle contraction, and nervous system function.⁷ Low magnesium intake may contribute to fatigue, muscle cramps, poor sleep, and increased stress sensitivity. Because only a small percentage of the body's magnesium is found in the bloodstream, serum magnesium levels do not always accurately reflect total body stores.⁷ While severe deficiency is uncommon, inadequate dietary intake is relatively common. Fatigue Isn't Always About Nutrients Nutrition is only one piece of the puzzle. Persistent fatigue can also be influenced by: Poor sleep quality or sleep disorders Chronic psychological stress Anxiety or depression Thyroid disorders Blood sugar dysregulation Chronic inflammation Certain medications Undiagnosed medical conditions¹ If fatigue is severe, worsening, or accompanied by symptoms such as unexplained weight loss, persistent fever, chest pain, shortness of breath, or fainting, it's important to seek prompt medical evaluation. What Should You Do If You're Always Tired? If you're wondering why you're always tired despite normal blood work, consider discussing a more comprehensive evaluation with your healthcare provider. Depending on your symptoms and medical history, they may recommend additional testing such as ferritin, vitamin B12, folate, vitamin D, thyroid function, or other investigations to help identify possible underlying causes. In the meantime, focusing on a nutrient-dense diet, prioritizing sleep, managing stress, engaging in regular physical activity, and addressing any identified nutrient deficiencies can all support healthy energy levels. Feeling tired all the time isn't something you should simply accept. While "normal" blood work can certainly be reassuring, it doesn't always tell the whole story. Looking beyond the basics may help uncover factors contributing to persistent fatigue and support a personalized approach to feeling your best. References (AMA) Aaronson LS, Teel CS, Cassmeyer V, et al. Defining and measuring fatigue. Image J Nurs Sch. 1999;31(1):45-50. doi:10.1111/j.1547-5069.1999.tb00420.x Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184(11):1247-1254. doi:10.1503/cmaj.110950 Houston BL, Hurrie D, Graham J, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomized controlled trials. BMJ Open. 2018;8(4):e019240. doi:10.1136/bmjopen-2017-019240 O'Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010;2(3):299-316. doi:10.3390/nu2030299 Bailey LB, Stover PJ, McNulty H, et al. Biomarkers of nutrition for development: folate review. J Nutr. 2015;145(7):1636S-1680S. doi:10.3945/jn.114.206599 Uwitonze AM, Razzaque MS. Role of magnesium in vitamin D activation and function. J Am Osteopath Assoc. 2018;118(3):181-189. doi:10.7556/jaoa.2018.037 Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7(9):8199-8226. doi:10.3390/nu7095388
Jul 31, 2026
4 min read
Epithelial Cell Abnormality: What You Need to Know

Epithelial Cell Abnormality: What You Need to Know

Kadia Bielecki
You go for your regularly scheduled cervical screening test, but this time the result says abnormal. Seeing that word can feel frightening, but an abnormal cervical screening result does not automatically mean that you have cervical cancer. In many cases, it reflects minor cell changes that resolve naturally or can be safely monitored over time.¹˒² In this article, we explain what epithelial cells are, what an epithelial cell abnormality means, how cervical screening results are classified, and what may happen next. https://youtu.be/3EwRV1AcPeU?si=87z1b1A48xapeUG- What Is an Epithelial Cell? Epithelial cells form the tissues that cover the outside of the body and line many internal organs, cavities, and passageways. These cells help create a protective barrier between the body and the external environment while also contributing to functions such as absorption, secretion, and immune defence.³ Epithelial tissue is found in areas including the: Skin Respiratory tract Digestive tract Urinary tract Reproductive tract Glands Cervix Epithelial cells are generally classified by their shape as squamous, cuboidal, or columnar. The cervix contains both squamous and glandular epithelial cells. Most cervical cell abnormalities identified during routine screening involve squamous cells found on the outer surface of the cervix.⁴ What Is an Epithelial Cell Abnormality? An epithelial cell abnormality means that cells collected from the cervix appear different from normal cells when examined under a microscope. These changes can develop for several reasons, including: Human papillomavirus infection Inflammation Hormonal changes Irritation Precancerous cervical changes Less commonly, cervical cancer Most abnormal cervical screening results are associated with HPV, particularly persistent infection with a high-risk HPV type. However, an abnormal result alone does not confirm precancer or cancer.¹˒⁵ The term cervical dysplasia is often used to describe abnormal cervical cell growth. Dysplasia is not cancer, but some higher-grade abnormalities can progress if they are not monitored or treated appropriately.¹˒⁶ What Is a Pap Test? A Pap test, also called cervical cytology, collects a small sample of cells from the cervix. The cells are then examined under a microscope for abnormalities that may indicate precancerous or cancerous changes.⁴ The test is named after Dr George Papanicolaou, whose work helped establish cervical cytology as a method of detecting cervical cancer at an earlier and more treatable stage.⁷ Cervical screening has significantly reduced cervical cancer incidence and mortality by allowing abnormal cells to be identified and managed before they progress to invasive cancer.⁸ Many screening programs are now transitioning from Pap testing alone to primary HPV testing, which looks for high-risk HPV types that can cause cervical cell changes. HPV testing is more sensitive than cytology for detecting cervical precancer.⁹ In Ontario, primary HPV testing became the standard cervical screening method in 2025. Most people with a cervix who are eligible for screening are now screened every five years rather than receiving a Pap test every three years. Screening recommendations vary by province, country, medical history, and previous results. Understanding Cervical Screening Results Cervical screening results may be reported as: Normal or Negative No high-risk HPV or abnormal cervical cell changes were identified, depending on the type of test performed. Unsatisfactory or Inadequate The laboratory could not properly assess the sample. This may happen if too few cells were collected or if blood, inflammation, or another substance obscured the sample. Repeat testing may be recommended.¹ Abnormal Abnormal cervical cells or a high-risk HPV infection were identified. The recommended follow-up depends on the exact result, HPV type, age, previous screening history, and estimated risk of developing a significant cervical lesion.¹˒² Modern guidelines do not manage every abnormal result in the same way. Instead, follow-up is increasingly based on a person’s combined current and previous results and their estimated risk of cervical intraepithelial neoplasia grade 3 or worse.¹˒² Common Abnormal Cervical Cytology Results Atypical Squamous Cells of Undetermined Significance ASC-US is one of the most common abnormal cervical cytology findings. It means that some squamous cells look slightly unusual, but the changes are not clearly precancerous. ASC-US may be associated with HPV, inflammation, irritation, hormonal changes, or another benign cause. Follow-up may involve HPV testing, repeat screening, or colposcopy depending on the individual’s age and previous results.¹˒⁴ Atypical Glandular Cells Atypical glandular cells, or AGC, are abnormalities involving cells from the cervical canal or uterine lining. Because glandular abnormalities may occasionally be associated with significant cervical or endometrial disease, additional evaluation is generally recommended. This may include colposcopy, sampling of the cervical canal, and, for some individuals, evaluation of the uterine lining.¹ Low-Grade Squamous Intraepithelial Lesion LSIL means that mild changes are present in the cervical squamous cells. These changes are usually associated with HPV infection and often regress naturally, particularly in younger people.⁴˒⁶ LSIL is a cytology result and is not exactly the same as CIN 1, which is a diagnosis made from a tissue biopsy. However, LSIL cytology frequently corresponds with low-grade histologic changes such as CIN 1.⁴ Atypical Squamous Cells, Cannot Exclude HSIL ASC-H means that abnormal squamous cells are present and that a high-grade lesion cannot be ruled out. Because ASC-H carries a higher risk of significant cervical precancer than ASC-US, colposcopy is generally recommended.¹ High-Grade Squamous Intraepithelial Lesion HSIL indicates cervical cell changes that have a greater likelihood of representing moderate or severe precancer. HSIL is commonly associated with histologic CIN 2 or CIN 3, although a biopsy is needed to determine the exact tissue diagnosis. HSIL is not the same as cervical cancer, but prompt evaluation is important because untreated high-grade lesions have a greater risk of progression.¹˒⁴ Adenocarcinoma In Situ Adenocarcinoma in situ, or AIS, is a precancerous abnormality involving glandular cells of the cervix. AIS has the potential to progress to invasive adenocarcinoma and usually requires diagnostic excision and careful follow-up.¹ Squamous Cell Carcinoma A cytology result suspicious for or consistent with squamous cell carcinoma means that malignant-appearing squamous cells were identified. This requires prompt diagnostic evaluation. A screening result alone may raise strong concern, but the final diagnosis is generally confirmed through colposcopy, biopsy, imaging, and other appropriate testing.¹ What Does Cervical Intraepithelial Neoplasia Mean? Cervical intraepithelial neoplasia, or CIN, is a histologic diagnosis made after a cervical tissue sample is examined by a pathologist. A Pap test or cervical cytology result does not directly diagnose CIN. CIN is usually identified through a biopsy taken during colposcopy.¹ CIN is divided into three grades: CIN 1 CIN 1 represents mild, low-grade cervical changes involving approximately the lower third of the cervical epithelium. Most CIN 1 lesions regress naturally without treatment. A systematic review found that approximately 60% of conservatively managed CIN 1 lesions regressed, while progression to cervical cancer was very rare.⁶ CIN 2 CIN 2 represents moderate abnormal changes. Some CIN 2 lesions regress, particularly in younger individuals, while others persist or progress. Management may involve treatment or careful observation depending on age, pregnancy plans, HPV status, the visibility of the lesion, and the ability to attend regular follow-up.¹˒⁶ CIN 3 CIN 3 represents severe precancerous changes involving most or all of the thickness of the cervical epithelium. CIN 3 is not invasive cervical cancer, but it carries a meaningful risk of progression if left untreated. Treatment is therefore generally recommended.¹˒⁶ Natural-history evidence shows that regression is common with CIN 1 and possible with CIN 2, while CIN 3 is more likely to persist and requires more active management. What Is an HPV Test? An HPV test looks for high-risk types of human papillomavirus associated with cervical precancer and cancer. Persistent high-risk HPV infection is the primary cause of cervical cancer. However, testing positive for HPV does not mean that you have cancer. Most HPV infections are controlled or cleared by the immune system within one to two years.⁵ HPV testing may be used: As the primary cervical screening test Alongside cytology To clarify the significance of certain abnormal cytology results During follow-up after colposcopy or treatment Some tests can identify HPV 16 and HPV 18 separately because these types are associated with a particularly high proportion of cervical cancers.⁵ How Often Should I Be Screened? Screening recommendations depend on where you live and your personal medical history. In Ontario, most eligible average-risk people with a cervix between ages 25 and 69 are now screened with an HPV-based cervical screening test every five years. People with previous abnormal results, immunosuppression, symptoms, or a history of cervical precancer may require a different schedule. Screening is intended for people without symptoms. Contact a healthcare provider rather than waiting for routine screening if you experience symptoms such as: Bleeding after sex Bleeding between periods Postmenopausal bleeding Unusual vaginal discharge Persistent pelvic pain What Happens After an Abnormal Result? An abnormal result does not always mean that you will be referred directly for colposcopy. Depending on your results and medical history, your healthcare provider may recommend: Repeat HPV testing Repeat cytology HPV genotyping Colposcopy Cervical biopsy Treatment of a confirmed high-grade lesion Current management is based on the estimated risk of developing CIN 3 or cancer rather than on a single test result alone. Some lower-risk abnormalities can be safely monitored, while higher-risk results require colposcopy or treatment.¹˒² What Is a Colposcopy? A colposcopy is a procedure that allows a trained healthcare provider to examine the cervix using a magnifying instrument called a colposcope. The colposcope remains outside the body. A speculum is inserted, similar to a cervical screening appointment, and solutions may be applied to the cervix to help highlight abnormal areas. Small tissue samples may be taken and sent to a laboratory. The biopsy results determine whether CIN or another abnormality is present and help guide further management.¹ How Are Abnormal Cervical Cells Treated? Not every cervical abnormality requires treatment. Lower-grade changes may be monitored because many regress naturally. Higher-grade lesions are more likely to require treatment.¹˒⁶ Treatment options may include excisional or ablative procedures. Loop Electrosurgical Excision Procedure LEEP, also called large loop excision of the transformation zone, uses a thin electrically heated wire loop to remove abnormal cervical tissue. LEEP allows the tissue to be examined by a pathologist and is commonly used to treat high-grade CIN.¹˒¹⁰ Cone Biopsy A cone biopsy removes a cone-shaped portion of cervical tissue. It may be recommended when glandular abnormalities are suspected, when the abnormal area extends into the cervical canal, or when a larger diagnostic specimen is required.¹ Ablative Treatment Ablative treatments destroy abnormal tissue rather than removing it for laboratory examination. Examples include: Cryotherapy Thermal ablation Laser ablation The appropriate procedure depends on the grade, size, location, and visibility of the lesion, whether cancer can be excluded, the person’s reproductive goals, and local clinical guidelines.¹˒¹⁰ Systematic reviews indicate that LEEP, cryotherapy, and cold-knife conization can all be effective in appropriately selected patients, although their risks, recurrence rates, and effects on future pregnancy differ.¹⁰˒¹¹ Can Lifestyle Habits Help My Body Respond to HPV? No food, herb, supplement, or lifestyle strategy has been proven to cure HPV or replace medical follow-up. However, healthy habits support normal immune function and overall health while your healthcare provider monitors or treats cervical abnormalities. Helpful habits may include: Avoiding smoking Eating a varied, nutrient-dense diet Exercising regularly Getting adequate sleep Managing chronic stress Limiting excessive alcohol intake Attending all recommended screening and follow-up appointments Smoking is associated with a higher risk of persistent HPV infection and cervical precancer, making smoking cessation particularly important.¹² Can Supplements Clear HPV or Reverse Abnormal Cells? Supplements should not be described as treatments that eradicate HPV or reliably return abnormal cervical cells to normal. Certain vitamins, minerals, and botanical ingredients contribute to normal immune function or are being studied in relation to HPV and cervical health. However, the evidence is not strong enough to guarantee viral clearance or regression of cervical abnormalities. Papillex® was formulated with vitamins, minerals, and botanical ingredients selected to support normal immune function and help address nutritional gaps. It should be used as part of a broader health plan and not as a replacement for cervical screening, colposcopy, biopsy, treatment, or other medical care. Always speak with a qualified healthcare provider before beginning a new supplement, particularly if you are pregnant, breastfeeding, taking medication, or undergoing treatment for a cervical abnormality. The Bottom Line An epithelial cell abnormality means that cells collected from the cervix appear different from normal cells. It does not automatically mean that you have cervical cancer. Many low-grade abnormalities regress naturally, while higher-grade findings require closer evaluation and may need treatment. The appropriate next step depends on your HPV results, cytology findings, biopsy results, previous screening history, age, and overall risk. The most important thing you can do is attend all recommended follow-up appointments and discuss your individual results with your healthcare provider. References Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525 Egemen D, Cheung LC, Chen X, et al. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. J Low Genit Tract Dis. 2020;24(2):132-143. doi:10.1097/LGT.0000000000000529 Higashi T, Saito AC, Chiba H. Damage control of epithelial barrier function in dynamic environments. Eur J Cell Biol. 2024;103(2):151410. doi:10.1016/j.ejcb.2024.151410 Nayar R, Wilbur DC, eds. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 3rd ed. Springer; 2015. Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers. 2016;2:16086. doi:10.1038/nrdp.2016.86 Loopik DL, Bentley HA, Eijgenraam MN, IntHout J, Bekkers RLM, Bentley JR. The natural history of cervical intraepithelial neoplasia grades 1, 2, and 3: a systematic review and meta-analysis. J Low Genit Tract Dis. 2021;25(3):221-231. doi:10.1097/LGT.0000000000000604 Tan SY, Tatsumura Y. George Papanicolaou (1883-1962): discoverer of the Pap smear. Singapore Med J. 2015;56(10):586-587. doi:10.11622/smedj.2015155 Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer. 2013;49(15):3262-3273. doi:10.1016/j.ejca.2013.04.024 Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346. doi:10.3322/caac.21628 Santesso N, Mustafa RA, Wiercioch W, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Int J Gynaecol Obstet. 2016;132(3):266-271. doi:10.1016/j.ijgo.2015.07.026 Hurtado-Roca Y, Becerra-Chauca N, Malca M. Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared with LEEP as therapy for cervical intraepithelial neoplasia: a systematic review. Rev Saude Publica. 2020;54:27. doi:10.11606/s1518-8787.2020054001750 International Collaboration of Epidemiological Studies of Cervical Cancer. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006;118(6):1481-1495. doi:10.1002/ijc.21493
Jul 29, 2026
11 min read
The IC Elimination Diet: How to Identify Your Personal Bladder Triggers

The IC Elimination Diet: How to Identify Your Personal Bladder Triggers

Kadia Bielecki
Living with interstitial cystitis or bladder pain syndrome can make eating feel unpredictable. A food that causes a painful flare for one person may have no effect on someone else, while a previously tolerated drink may suddenly seem to worsen urgency, frequency, or pelvic discomfort. This is why there is no single universal “IC diet.” Current research suggests that the most useful dietary approach may be a personalized elimination diet designed to identify your individual bladder triggers without unnecessarily restricting foods long term. A recent systematic review found that individualized elimination diets may improve pain and other IC/BPS symptoms, although the available evidence remains limited and larger studies are still needed.¹ Here is how to approach an elimination diet safely and practically. What Is Interstitial Cystitis? Interstitial cystitis/bladder pain syndrome, or IC/BPS, is a chronic condition associated with pain, pressure, or discomfort perceived to come from the bladder, often alongside urinary urgency and frequency. Symptoms can vary significantly between individuals and may fluctuate between more manageable periods and symptom flares.² IC/BPS is not considered one uniform disease. Different biological, pelvic floor, neurological, inflammatory, and psychosocial factors may contribute to symptoms, which is one reason treatment often needs to be individualized. Current clinical guidance supports a multimodal approach that may include dietary management, pelvic-floor physiotherapy, stress support, pain management, medication, and other therapies selected according to the individual.³ Can Food Trigger an IC Flare? Many people with IC/BPS report that certain foods and beverages worsen bladder pain, urgency, or frequency. Survey-based studies have repeatedly identified coffee, tea, alcohol, carbonated drinks, citrus, tomatoes, artificial sweeteners, and spicy foods as commonly reported triggers.⁴⁻⁶ However, that does not mean everyone with IC needs to avoid every food on this list. In one large survey, most participants reported at least one dietary sensitivity, but most of the hundreds of individual foods examined had no effect on symptoms.⁴ This highlights an important point: your personal response matters more than following an overly restrictive generic food list. Stress, infections, physical activity, prolonged sitting, sexual activity, tight clothing, and other factors may also contribute to flares. Food is only one possible part of the picture.⁷ What Does the Latest Research Say? A 2026 systematic review examined four dietary intervention studies involving 147 people with IC/BPS. The researchers found that an individualized elimination diet produced improvements in pain and validated symptom scores after 12 months. A shorter online dietary coaching intervention also improved pain and urgency.¹ By comparison, the review found no clear benefit from an anti-inflammatory diet or hydrogen-rich water in the small studies available.¹ These results are encouraging, but they should be interpreted cautiously. Only a small number of studies met the researchers’ inclusion criteria, and the interventions differed considerably. The evidence does not support prescribing one strict eating plan to everyone with IC/BPS. Instead, the findings support using a structured process to identify personal triggers while preserving a nutritionally balanced and varied diet. This personalized approach was also specifically highlighted in the internal Wellex discussion of the study. How to Run Your Own IC Elimination Diet An elimination diet is a short-term experiment, not a permanent way of eating. The goal is to temporarily remove likely triggers, monitor your symptoms, and then reintroduce foods systematically. Step 1: Establish Your Baseline Before changing your diet, track your symptoms and usual food intake for approximately one to two weeks. Record: Meals, snacks, and beverages Bladder pain or pressure Urgency and frequency Nighttime urination Pelvic-floor discomfort Stress, sleep, and menstrual-cycle changes Medications and supplements The timing and duration of any flare Using a simple rating scale, such as 0 to 10, can make patterns easier to recognize. Try not to change several lifestyle factors at once. If you simultaneously alter your diet, supplements, exercise routine, sleep schedule, and medications, it may become difficult to tell what actually affected your symptoms. Step 2: Temporarily Remove Your Most Likely Triggers For approximately two to four weeks, consider removing the foods and drinks most strongly associated with your symptoms. Frequently reported triggers include: Coffee and caffeinated tea Alcohol Carbonated drinks Citrus fruits and juices Tomatoes and tomato-based sauces Spicy foods Artificial sweeteners Highly acidic beverages Chocolate Large supplemental doses of vitamin C This is not a list of foods that every person with IC must avoid. Begin with the items you consume regularly or already suspect may affect you. Continue eating enough protein, fibre, carbohydrates, healthy fats, fruits, and vegetables from foods you tolerate. An elimination phase should not leave you eating only a handful of “safe” foods. Step 3: Monitor Your Symptoms Continue your symptom diary during the elimination period. Look for meaningful changes in: Pain intensity The length or frequency of flares Urinary urgency Daytime and nighttime frequency Your ability to tolerate normal activities Your overall quality of life Symptoms may naturally fluctuate, so one good or bad day does not necessarily prove that a food is helpful or harmful. Look for patterns that repeat over several days. Step 4: Reintroduce Foods One at a Time Once your symptoms have reached a more stable baseline, begin reintroducing one eliminated item at a time. Start with a small portion on the first day and increase to a normal portion if tolerated. Monitor your symptoms for approximately two to three days before testing another food. For example: Add a small amount of tomato to one meal. Record symptoms for the remainder of the day and the following two days. Return to your baseline diet if symptoms worsen. Wait until the flare settles before testing something else. Testing one item at a time makes it easier to identify the likely cause of a reaction. Step 5: Find Your Personal Threshold Food reactions are not always all or nothing. You may find that: One small coffee is tolerable, but two are not. Fresh tomato causes no symptoms, but concentrated tomato sauce does. A trigger is tolerated when your symptoms are stable but not during a flare. Alcohol causes symptoms only when combined with dehydration or poor sleep. A mildly spicy meal is manageable, but a very spicy meal is not. Your final plan may involve limiting the quantity, frequency, or timing of certain foods rather than eliminating them completely. Avoid Making the Diet More Restrictive Than Necessary Overly restrictive diets can make it harder to meet nutritional needs and may increase anxiety around eating. They can also become difficult to maintain socially and financially. The aim is to build the widest and most enjoyable diet you can tolerate, not to eliminate every food that appears on an online IC list. Consider working with a registered dietitian or qualified healthcare provider if: You are losing weight unintentionally. You have several food allergies or intolerances. You are avoiding entire food groups. You are pregnant or breastfeeding. You have diabetes, kidney disease, an eating-disorder history, or another condition affecting nutrition. You cannot identify clear patterns despite repeated symptoms. What Can You Eat During the Elimination Phase? Tolerance differs, but many people begin with relatively simple, minimally processed foods such as: Oats, rice, quinoa, potatoes, and other tolerated grains or starches Eggs, poultry, fish, tofu, beans, or lentils Non-citrus fruits such as pears, blueberries, or melon Vegetables such as carrots, cucumber, squash, leafy greens, or green beans Olive oil, avocado, nuts, and seeds, if tolerated Water and non-caffeinated, non-acidic beverages Even commonly recommended “bladder-friendly” foods can trigger symptoms in some individuals, so continue to use your own symptom response as your guide. What if Removing Trigger Foods Does Not Help? Dietary changes are only one potential part of IC/BPS management. Symptoms may also be influenced by pelvic-floor muscle tension, central pain sensitization, stress, poor sleep, hormonal changes, constipation, sexual activity, infections, and other health conditions.³˒⁷ A lack of improvement with dietary changes does not mean your symptoms are not real. It may simply mean that food is not one of your primary drivers. Speak with your healthcare provider about other strategies, which may include pelvic-floor physiotherapy, bladder training, stress and nervous-system support, medication, pain management, or further evaluation. Seek medical care promptly if you develop fever, visible blood in your urine, new back or flank pain, vomiting, difficulty urinating, or symptoms that may suggest a urinary tract infection or another acute condition. The Bottom Line There is no single IC diet that works for everyone. The best available evidence suggests that a carefully planned, individualized elimination diet may help some people reduce bladder pain, urgency, and other symptoms. However, the research remains limited, and dietary changes should complement rather than replace medical care.¹ Start by tracking your current symptoms, temporarily remove only your most likely triggers, and reintroduce foods one at a time. The goal is not lifelong restriction. It is to understand your body, identify meaningful patterns, and create a varied eating plan that supports both bladder comfort and overall nutrition. References Alahmed FB, Hall A, Rhodes S, Jarvis M, Sheyn D. Interstitial cystitis and dietary interventions: a systematic review. Int Urogynecol J. Published online June 4, 2026. doi:10.1007/s00192-026-06572-0 Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545-1553. doi:10.1016/j.juro.2015.01.086 Zimmermann PV, Gonsior A, Vahlensieck W, et al. Update of the S2k guideline on the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Urologie. 2026;65(5):506-512. doi:10.1007/s00120-026-02812-9 Bassaly R, Downes K, Hart S. Dietary consumption triggers in interstitial cystitis/bladder pain syndrome patients. Female Pelvic Med Reconstr Surg. 2011;17(1):36-39. doi:10.1097/SPV.0b013e3182044b5c Friedlander JI, Shorter B, Moldwin RM. Diet and its role in interstitial cystitis/bladder pain syndrome and comorbid conditions. BJU Int. 2012;109(11):1584-1591. doi:10.1111/j.1464-410X.2011.10860.x Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol. 2007;178(1):145-152. doi:10.1016/j.juro.2007.03.020 Lai HH, Vetter J, Jain S, et al. Management of symptom flares and patient-reported flare triggers in interstitial cystitis/bladder pain syndrome: findings from one site of the MAPP Research Network. Urology. 2019;126:24-33. doi:10.1016/j.urology.2019.01.012
Jul 27, 2026
7 min read
Herbs for HPV

Herbs for HPV

Kadia Bielecki
As awareness of human papillomavirus (HPV) continues to grow, many people are looking for natural ways to support their immune system and overall health after receiving an HPV diagnosis. While there is no herbal treatment that cures HPV, some herbs have been studied for their antiviral, antioxidant, and immunomodulatory properties that may support normal immune function.¹⁻³ Lifestyle habits remain the foundation of immune health. Eating a nutrient-dense diet, exercising regularly, getting enough sleep, managing stress, and avoiding smoking all play important roles in supporting your body's natural immune response; not just against HPV, but against infections in general.⁴˒⁵ Below, we'll explore some of the most commonly studied herbs and botanicals for HPV and what the current research says about each. https://www.youtube.com/watch?v=QLqKN-tEw7c&t=229s Herbal Remedies Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. While most HPV infections are cleared naturally by the immune system within one to two years, persistent infection with certain high-risk HPV types can increase the risk of cervical cancer and several other cancers.⁶˒⁷ Although researchers continue to investigate natural approaches that may support immune function, no herbal remedy has been proven to eliminate HPV infection. However, not all botanicals have the same level of scientific evidence. Some herbs have been evaluated in human clinical studies for HPV-related conditions and currently have the strongest clinical support, while others have demonstrated promising antiviral, antioxidant, or immunomodulatory effects primarily in laboratory, animal, or early-stage human research. Below, we'll explore the herbs with the strongest evidence first, followed by botanicals with emerging research. Herbs With the Strongest Clinical Evidence Green Tea Extract Green tea extract is one of the most extensively researched botanical ingredients for HPV-related conditions. Its primary active compound, epigallocatechin gallate (EGCG), has demonstrated antiviral, antioxidant, and anti-inflammatory properties in laboratory research.⁶ Studies suggest EGCG may interfere with several stages of viral infection and influence cellular pathways involved in abnormal cell growth.⁶˒⁷ Among all botanical therapies studied for HPV-related conditions, standardized green tea extract (sinecatechins 15% ointment) currently has some of the strongest clinical evidence. It is approved for the topical treatment of external genital and perianal warts, making it one of the few botanical products supported by randomized clinical trials for HPV-related lesions.⁸ It is important to note that this topical medication is different from taking oral green tea supplements, which have not been shown to treat HPV infection. Read our latest post about green tea extract and cervical health to learn more. Reishi Mushroom Extract Reishi mushroom (Ganoderma lucidum) has been used for centuries in traditional medicine and is one of the best-studied medicinal mushrooms for immune support. Research suggests that polysaccharides and triterpenes found in reishi may influence several aspects of immune function, including macrophages, dendritic cells, natural killer cells, and T lymphocytes.⁴˒⁵ These compounds have also demonstrated antioxidant and anti-inflammatory properties in laboratory studies.⁵ Reishi has one of the largest bodies of research supporting its effects on immune regulation among medicinal mushrooms. More well-designed human studies are still needed to determine its role in supporting HPV clearance.⁴˒⁵ Echinacea Echinacea (Echinacea purpurea) is one of the most popular herbal remedies for supporting immune health and is commonly used during cold and flu season. Research suggests that echinacea possesses immunomodulatory, anti-inflammatory, and antiviral properties. Laboratory studies have demonstrated activity against several respiratory viruses, although results from human clinical trials have been mixed depending on the preparation used.⁹˒¹⁰ A small number of studies have investigated echinacea alongside conventional treatment for HPV-related cervical lesions, suggesting it may help support immune function and reduce recurrence in certain populations.¹¹ However, larger, high-quality clinical trials are needed before echinacea can be recommended specifically for HPV management. Echinacea is available as capsules, tinctures, teas, and liquid extracts. Astragalus Astragalus (Astragalus membranaceus) has been used in Traditional Chinese Medicine for centuries and is one of the most extensively studied herbs for supporting immune health. Laboratory and animal studies suggest that astragalus may help regulate immune function by influencing macrophages, natural killer (NK) cells, T lymphocytes, and cytokine production.¹˒² Rather than "boosting" the immune system, researchers generally describe astragalus as having immunomodulatory properties, meaning it may help support a balanced immune response.² Some preclinical studies have also investigated astragalus for its effects on cervical cancer cells and HPV-related cellular pathways. Additional human clinical research is needed to determine its independent role in supporting HPV clearance.²˒³ Astragalus is commonly available as capsules, powders, teas, and liquid extracts. Herbs With Emerging Evidence While the herbs below have demonstrated antiviral, antioxidant, or immunomodulatory activity in laboratory studies, animal models, or early human research, they currently have less clinical evidence for HPV than other leading immune-supportive botanicals. They may be considered supportive or adjunctive therapies. Thuja Oil and Tea Tree Oil Tea tree oil (Melaleuca alternifolia) and thuja oil have traditionally been used for a variety of skin conditions because of their antimicrobial properties. Laboratory studies have demonstrated antibacterial, antifungal, and antiviral activity for tea tree oil, although clinical evidence for HPV is limited.⁸˒⁹ Tea tree oil has occasionally been used topically for common and genital warts, but the evidence supporting its effectiveness is largely limited to case reports rather than large clinical trials.¹⁰ Because essential oils can cause skin irritation or allergic reactions, they should always be diluted appropriately and used with caution. Goldenseal Goldenseal (Hydrastis canadensis) is one of North America's most well-known medicinal herbs and has traditionally been used to support immune health. Its primary active compound, berberine, has demonstrated antimicrobial, anti-inflammatory, and antioxidant properties in laboratory and animal studies.¹¹ Researchers have also investigated berberine for its potential effects on cellular pathways involved in abnormal cell growth and angiogenesis.¹² While these findings are promising, there is currently very limited clinical evidence evaluating goldenseal or berberine specifically for HPV infections or HPV clearance. More high-quality human studies are needed before conclusions can be drawn.¹¹˒¹² Curcumin Curcumin is the primary bioactive compound found in turmeric (Curcuma longa) and has been widely studied for its antioxidant and anti-inflammatory effects. Laboratory studies suggest curcumin may influence cellular signaling pathways involved in inflammation, oxidative stress, abnormal cell growth, and programmed cell death (apoptosis).¹² Researchers have also investigated curcumin for its potential effects on HPV oncogene expression in cervical cancer cells.¹³ While these findings are encouraging, most evidence comes from laboratory and preclinical research, and more human clinical studies are needed. Garlic Garlic (Allium sativum) has been valued as both a food and medicinal plant for centuries. Compounds naturally present in garlic, including allicin and other sulfur-containing molecules, have demonstrated antimicrobial, antioxidant, and immunomodulatory properties in laboratory studies.¹⁴ Garlic has also been investigated for its ability to support natural killer cell activity and other components of the immune response.¹⁵ Although garlic contributes to an overall healthy diet and may support immune function, there is currently limited direct clinical evidence showing that garlic improves HPV clearance or treats HPV-related disease. More research is needed. Birch Bark Birch bark has a long history of traditional use for supporting skin health and wound healing. One of its naturally occurring compounds, betulin, has demonstrated anti-inflammatory, antioxidant, and tissue-repair properties in laboratory and clinical studies involving wound healing.¹˒² Although some traditional remedies have used birch bark preparations for warts, there is currently very little clinical evidence supporting its use specifically for HPV-related lesions or HPV infection. More research is needed before it can be recommended for this purpose.² Ginkgo Biloba Ginkgo biloba is one of the most widely studied botanical supplements for cognitive health, but it has also demonstrated antioxidant and anti-inflammatory properties in laboratory research.³ Certain compounds found in ginkgo, including ginkgolic acids, have shown antiviral and anticancer activity in preclinical studies by influencing viral entry and cellular signaling pathways.⁴ However, there are currently no high-quality human clinical trials demonstrating that ginkgo improves HPV clearance or treats HPV-related disease. Olive Leaf Olive leaf extract contains several polyphenols, including oleuropein and hydroxytyrosol, which possess antioxidant and anti-inflammatory properties.⁵ Laboratory studies suggest olive leaf compounds may have antiviral activity against several viruses and may influence cellular pathways involved in oxidative stress and inflammation.⁵˒⁶ Some preclinical studies have also investigated olive-derived compounds in cervical cancer cells, although **there is currently no clinical evidence demonstrating that olive leaf treats HPV infection or promotes HPV clearance in humans.**⁶ Other Botanicals Under Investigation Several other herbs have been investigated for their potential to support immune function or provide antioxidant activity, including: Bayberry Horehound Red clover Fenugreek Hawthorn While many of these botanicals contain compounds with antioxidant or anti-inflammatory properties, clinical evidence supporting their use specifically for HPV remains limited. More research is needed to determine whether they play a role in HPV management.⁷ Herbal supplements are available in many forms, including capsules, tinctures, teas, powders, and topical preparations. It's important to remember that "natural" does not always mean "safe." Herbs can interact with prescription medications, may not be appropriate during pregnancy or breastfeeding, and can cause side effects in some individuals. Always consult your healthcare provider before beginning a new herbal supplement.⁸ Conclusion While there is growing interest in natural approaches for supporting immune health, no herb has been proven to cure HPV or reliably eliminate persistent HPV infection. However, several botanicals; including green tea extract, astragalus, reishi mushroom, echinacea, curcumin, and garlic; have demonstrated promising antiviral, antioxidant, or immunomodulatory properties that continue to be investigated in scientific research.¹˒⁵˒⁹ The strongest evidence for supporting your body's response to HPV continues to include: Staying up to date with recommended cervical screening.¹⁰ Not smoking, as smoking is associated with an increased risk of persistent HPV infection and cervical dysplasia.¹¹ Eating a nutrient-rich diet that supports normal immune function.¹² Exercising regularly and managing stress.¹² Getting adequate sleep each night.¹³ Working with your healthcare provider to determine whether targeted nutritional supplementation may be appropriate for you. If you're looking for a supplement designed to complement these healthy lifestyle habits, Papillex® combines several evidence-supported vitamins, minerals, and botanical ingredients selected to support normal immune function and overall wellness. It is intended to be used as part of a comprehensive approach that includes a healthy lifestyle and regular medical follow-up, not as a replacement for routine cervical screening or medical care.
Jul 24, 2026
8 min read

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