Medical News Today: How to stop bleeding on Depo-Provera

Depo-Provera is a form of birth control taken via shot. Breakthrough bleeding, spotting, and changes to menstrual flow are some of the most common side effects during the first year of use. However, there are some home remedies that can help.

Irregular bleeding is normal on Depo-Provera. Around 57 percent of people who have this shot experience irregular bleeding or spotting 12 months after doing so, and 32 percent of people do at 24 months.

This symptom usually improves the longer people use the medication. Clinical trials show that 55 percent of those using Depo-Provera no longer have any bleeding after 12 months.

For people who experience this symptom, there are some home remedies to try. These include taking ibuprofen, wearing sanitary towels, and learning to anticipate the bleeding.

Remedies for irregular bleeding

Period pad or panty liners, tampons, and menstrual cup.
Having sanitary towels or tampons on hand can help make irregular bleeding more manageable.

Abnormal bleeding is a common side effect of Depo-Provera, especially within the first year of starting the therapy. Bleeding irregularities that typically occur may include:

  • breakthrough bleeding
  • spotting between periods
  • prolonged periods
  • lighter or heavier periods than normal
  • lack of period, usually after 1 year

Remedies that may help include the following:

1. Taking ibuprofen

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce the inflammation and pain that may come with abnormal uterine bleeding.

A 2013 review from the Cochrane Database of Systematic Reviews notes that taking a type of NSAID called mefenamic acid may help decrease the duration of bleeding in people undergoing Depo-Provera therapy.

Everyone responds to medications differently, so it is important to discuss dosage to relieve Depo-Provera-related bleeding and discomfort with a doctor.

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2. Accepting that it is a normal symptom

One of the easiest ways to cope with Depo-Provera-related bleeding is to recognize that it is a normal symptom.

However, it is not normal to have very painful or heavy bleeding. People should see a doctor for evaluation in these cases.

While abnormal bleeding can be irritating and alarming, keep in mind that some irregular bleeding or spotting during the early months of Depo-Provera therapy typically means that the body is adjusting to the medication.

Knowing, and accepting, that some light irregular bleeding may happen can help most people manage this frustrating side effect.

3. Wearing pads, protective underwear, or tampons

Irregular bleeding can ruin clothing. An unexpected heavy period is an experience that most people find unpleasant.

Being able to anticipate an abnormal flow when starting Depo-Provera therapy may help a person plan to wear pads, protective underwear, or tampons during the adjustment months.

This can help save money and frustration. It can also be beneficial to carry around an extra pad or tampon, or even a pair of underwear, for the first year or so after starting Depo-Provera therapy.

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4. Stopping Depo-Provera therapy

Woman receiving injection of vaccine shot in arm.
People experiencing severe side effects on Depo-Provera should discuss different birth control options with a doctor.

If irregular bleeding becomes too much to deal with or threatens someone’s health by putting them at risk for anemia, stopping Depo-Provera therapy may be the best choice.

After injecting the medication, it takes at least 3 months to wear off. For this reason, it is not possible to simply stop taking Depo-Provera.

However, as soon as the 3-month mark passes, Depo-Provera quickly becomes ineffective. So, if side effects are severe, it may be best to simply stop the therapy and wait for the medicine to leave the system.

It is relatively easy to stop Depo-Provera therapy without medical approval. However, it is still important to talk with a doctor about the consequences of stopping, such as becoming pregnant.

It is also vital to discuss the side effects with a doctor, especially regarding how long to anticipate symptoms for, before quitting the therapy. The side effects are usually minor and temporary.

5. Undergoing estrogen therapy

If appropriate, a doctor may recommend estrogen therapy for those with irregular bleeding during Depo-Provera therapy.

Many of the studies exploring the use of estrogen therapy for this purpose focus on the use of transdermal estradiol patch specifically. This includes a clinical trial from 2011 in the American Journal of Obstetrics and Gynecology.

A doctor may suggest other types of hormone therapy. Other studies recommend oral contraceptives.

Estrogen therapy may not be safe for everyone. A person should always talk with a doctor about the side effects, and the side effects of Depo-Provera, before deciding how to treat irregular bleeding.

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Abnormal uterine bleeding is the most common side effect of Depo-Provera therapy, especially in the early months of use.

A person should talk with a doctor whenever bleeding continues for more than 14 days, is heavy, or symptoms such as pelvic pain accompany it.

People should also seek medical care if there is persistent pain, pus, or bleeding from the Depo-Provera injection site.

Abnormal bleeding during Depo-Provera therapy is not always a side effect of medication usage. Depo-Provera-related uterine bleeding can hide other underlying conditions.

A doctor will need to rule out other potential causes of uterine or vaginal bleeding before determining the best course of treatment.

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Medical News Today: Mediterranean diet reduces cardiovascular risk by a quarter

A recent study has put the Mediterranean diet to the test once more, attempting to unpick the molecular mechanisms that produce its benefits.
Mediterranean diet couple dinner
More good news for advocates of the Mediterranean diet.

Inspired by the traditional eating patterns of people from Greece, Italy, and Spain, the Mediterranean diet can seemingly do no wrong.

In a nutshell, the diet is rich in plants and olive oil but low in meat and sugary products.

Over the years, studies have concluded that this eating pattern lowers the risk of various health issues, including coronary heart disease and stroke.

Studies have even concluded that the Mediterranean diet might extend lifespan in older adults as well as reduce the risk of Parkinson’s and Alzheimer’s.

Evidence is mounting for its health benefits, but scientists still do not know exactly how these benefits come about.

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The Mediterranean black box

A new study published in JAMA Network Open asks the following question: “Is the Mediterranean diet […] associated with lower risk of cardiovascular disease (CVD) events in a [United States] population, and, if so, what are the underlying mechanisms?”

As corresponding study author Dr. Samia Mora explains, “While prior studies have shown benefit for the Mediterranean diet on reducing cardiovascular events and improving cardiovascular risk factors, it has been a black box regarding the extent to which improvements in known and novel risk factors contribute to these effects.”

To investigate, the scientists took data from the Women’s Health Study. Lead study author Shafqat Ahmad, Ph.D., led researchers from Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health — all in Boston, MA.

In all, they had access to the health records and dietary habits of 25,994 women, all of whom were healthy at the start of the study. The researchers followed them for a maximum of 12 years.

The researchers measured the levels of 40 biomarkers, including lipids, inflammation, glucose metabolism, and lipoproteins. They split the participants into three groups — low, middle, and upper intake — depending on how strictly they adhered to the Mediterranean diet.

They were particularly interested in cardiovascular events, such as stroke and heart attack. They found that:

  • In the low intake group, 4.2 percent of women had a cardiovascular event.
  • In the middle intake group, 3.8 percent of women had a cardiovascular event.
  • In the upper intake group, 3.8 percent of women had a cardiovascular event.

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This marks the first long-term study in a U.S. population to explore the impact of the Mediterranean diet on CVD. The authors conclude:

[H]igher [Mediterranean diet] intake was associated with approximately one-quarter lower risk of CVD events over a 12-year follow-up period.”

The authors also note that this effect size is equivalent to that present in people who take statins, which are common drugs that doctors prescribe to lower cardiovascular risk.

Mediterranean metabolites

Next, they dived into the metabolic data to see if they could find any patterns. They discovered that variation in metabolites related to inflammation accounted for 29 percent of the reduction in CVD risk.

Glucose metabolism and insulin resistance accounted for 27.9 percent, body mass index (BMI) for 27.3 percent, and blood pressure for 26.6 percent.

The team also noted relationships between a number of other metabolites, including lipids, but these were less pronounced.

Dr. Mora says, “In this large study, we found that modest differences in biomarkers contributed in a multifactorial way to this cardiovascular benefit that was seen over the long-term.”

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Once again, the Mediterranean eating pattern seems to have come up trumps; and now we know that its benefits are most likely due to the way it interacts with inflammation pathways, glucose metabolism, and insulin resistance.

Of course, there are some limitations to the study. For instance, as the authors explain, CVD risk could have been influenced by as-yet-unknown metabolic factors that the scientists did not measure in this study.

Also, the dietary information that they analyzed relied on the participants keeping a food diary, which comes with a potential for human error. However, the size of this study and the detailed information about biomarkers make this a relatively reliable research endeavor.

As evidence in favor of the Mediterranean diet mounts, its popularity is sure to continue climbing.

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Medical News Today: What is it like to live with HIV?

Recent advances in HIV treatment mean that people with the virus can now enjoy a better quality of life and longer lifespan than ever before. For most people, this diagnosis does not affect their ability to work, go to school, or socialize.

HIV currently affects around 1.1. million people in the United States. Generally, these people can lead a similar life to the one they had before they contracted HIV.

However, they will need to take HIV medications and go for checkups regularly.

People with HIV also need to take additional steps to stay healthy and to avoid transmitting the virus to others.

In this article, we describe some of the challenges that people living with HIV may face, as well as some of the things they may have to consider.

Taking medications

group of mature men smiling
Antiretroviral therapy can help a person with HIV stay healthy.

Taking medication and attending checkup appointments are vital components of living with HIV.

Treatment for HIV is most successful when people take an active role in their own care.

The U.S. Department of Health and Human Services advise that everyone with HIV undergo antiretroviral therapy. This course of treatment helps such people stay in good health and prevents transmission of the virus to others.

To keep HIV under control, people will need to take their medicines every day, exactly as their doctor recommends. They will also need to attend regular appointments to monitor the treatment and its effectiveness.

This means that people must track their medication use, medical appointments, symptoms, and more. Using a tracking chart can be helpful.

Being aware of opportunistic infections and cancers

People with HIV who do not seek the appropriate treatment have a higher risk of developing several opportunistic infections (OIs) and cancers.

Antiretroviral medications and vaccinations provide the best chance of avoiding complications, but people with HIV should monitor their health closely and beware of signs and symptoms of OIs and cancers.

It is important that people with HIV discuss the ways to reduce OI risk with their healthcare provider. Those who develop OIs can take antibiotics, antifungal medications, and other treatments.

Leading a healthful lifestyle

Eating a healthful diet and taking regular exercise is important for everyone, but it is especially so for people with HIV. These actions keep the immune system strong and able to fight infection.

Basic dietary principles include:

  • eating plenty of fruits, vegetables, and whole grains
  • choosing lean sources of protein, such as fish, poultry, legumes, or tofu
  • consuming healthful fats, such as those from nuts, avocado, or olive oil
  • limiting processed foods, or foods high in sugar or salt

People with HIV may sometimes experience problems that affect their ability to consume or digest certain foods. This may occur because HIV medications can lead to stomach issues or infections that affect the ability to swallow.

It might be helpful to work with a dietician or other healthcare professional to avoid nutrient deficiencies and excess weight loss or gain.

Getting regular exercise is also important. Exercise can boost immune function, stimulate the appetite, improve mental health, and prevent constipation.

Those with HIV can typically enjoy the same types of exercise as those without the virus, as long as their healthcare provider approves the activity.

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Practicing food safety

People with stage 3 HIV, or AIDS, are more likely to develop OIs because they have lower immune function.

It is important to avoid sources of potential infections, including foods that germs are likely to infect.

Foodborne illnesses can be severe for people with HIV and may cause longer recovery periods, hospitalization, or even death.

The following tips can help prevent complications:

  • Practice good food hygiene when preparing, storing, and eating foods.
  • Avoid raw meat, seafood, and eggs, and unpasteurized dairy products.
  • Never drink water directly from lakes or rivers, as it is untreated.
  • When in a country with lower hygiene standards, only drink bottled water, avoid ice, and do not eat peeled fruits or vegetables.

Not smoking, taking drugs, or drinking alcohol

group of friends in the pub
Not smoking and limiting alcohol will help improve the immune system.

Staying in the best possible health is important for people with HIV, as it can help prevent a range of complications.

To keep the immune system strong, these people should consider the following lifestyle choices:

  • quitting smoking
  • limiting or avoiding alcohol
  • limiting or avoiding recreational drugs

Smoking increases the risk of lung cancer, some other cancers, and other lung problems, and people with HIV are at greater risk of complications. Research from 2017 suggests a high rate of tobacco use in people with HIV.

Other research indicates that alcohol use occurs frequently in people with HIV, and the authors link it to poor treatment response and more rapid viral progression. Drug use may have similar effects.

For support quitting smoking, speak to a healthcare professional or call the state quitline on 1-800-QUIT-NOW (1-800-784-8669). A healthcare provider can also give advice and information on limiting or avoiding alcohol and drugs.

Talking to others about HIV

Having the support of other people can make it much easier to navigate certain challenges.

It can be beneficial to talk to a friend or family member. Other options include joining a support group or seeing a therapist.

It is not necessary for people to disclose the status of their condition to friends, employers, or colleagues. However, doing so can have practical and emotional advantages, especially in relation to taking time off work.

A person’s sexual partners should know about their HIV status. Disclosing this information gives the person with HIV legal protection and allows others to make their own decisions.

Some states require people with HIV to share their diagnosis with sexual or drug-using partners. The Center for HIV Law and Policy offers more information on disclosure and HIV-specific laws.

For more information on disclosing HIV status to other people, the charity Avert and the Centers for Disease Control and Prevention (CDC) offer some useful guidance.

Some local state departments may also inform sexual or drug partners of a person’s HIV status if necessary.

Dealing with stigma

Despite considerable advances in treatment, some people with HIV may still face stigma and discrimination. These prejudices often result from myths, fears, or a lack of education surrounding the condition.

However, the Americans with Disabilities Act protects people with HIV from discrimination. People who feel that they have been discriminated against because of their HIV diagnosis can file a complaint.

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Managing stress and supporting mental health

Living with HIV can increase stress or lead to depression or anxiety. However, a person should aim to protect their mental health to feel good, avoid HIV-related complications, and ensure a longer life.

People who experience symptoms of depression and anxiety should speak to their healthcare provider or a mental health professional.

Depression and anxiety are highly treatable with medications and some lifestyle changes. To manage stress and mood disorders, people can engage in relaxation activities such as:

  • alternative therapies such as acupuncture, massage, or aromatherapy
  • art or music therapies
  • deep-breathing techniques
  • enjoyable hobbies
  • exercise
  • meditation and mindfulness
  • progressive muscle relaxation
  • yoga

Preventing HIV transmission

People with HIV should:

  • use condoms correctly during all sexual activity
  • not share needles or other drug-related equipment
  • seek treatment for other sexually transmitted infections

People who are pregnant should take their medication as their doctor says they should throughout the pregnancy, labor, and breastfeeding stages.

Getting enough sleep

man reading in bed
Reading before bedtime can help a person establish a regular sleep pattern.

Adequate sleep is essential for physical and mental health, including for immune function.

Research estimates that up to 70 percent of people with HIV experience sleep problems. These may result from:

  • depression or anxiety
  • HIV medications
  • HIV-related conditions and symptoms
  • sleep apnea
  • worries about finances, relationships, or stigma

Aim to sleep for 7–9 hours each night. To achieve this:

  • go to bed and get up at the same time each day, including on the weekend
  • establish a bedtime routine that may include taking a warm bath, reading, or drinking an herbal tea

People can speak to a healthcare provider about ongoing or severe sleep issues. Solutions may include changing to another medication, taking sleeping pills, seeing a therapist, or making lifestyle changes.


Receiving a diagnosis of HIV can be overwhelming. Realistically, everyone’s life is different and how they deal with their diagnosis will be unique.

With appropriate treatment and self-care, people with HIV can live long, happy, and fulfilling lives. Many aspects of living with HIV are similar to living without HIV.

For example, regardless of HIV status, people should strive to eat a healthful diet, exercise regularly, avoid smoking, and limit or avoid using alcohol and drugs. Managing stress and getting enough sleep are also essential for well-being.

People with HIV need to consider additional factors in their daily lives, including remembering to take their medication, seeing their healthcare provider regularly, and monitoring their health closely for signs of OIs.

They should also take steps to avoid transmitting the virus, and they should find ways to tell their sexual partners and drug partners about their diagnosis.

Although living with HIV can be difficult, there are a lot of support systems available, including from healthcare professionals, support groups, family, friends, and the legal profession.

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Medical News Today: New brain circuit that controls anxiety found

A previously unknown brain mechanism that regulates anxiety has come to light. It allows a gene-altering protein to enter the nucleus of brain cells.
brain illustration on pink background
New research uncovers a brain mechanism that controls anxiety.

The protein goes by the name of methyl-CpG binding protein 2 (MeCP2), and scientists have linked it to anxiety behaviors.

The recent research could lead to new treatments for anxiety disorders that have fewer side effects, according to the team that carried it out at the Weizmann Institute of Science in Israel.

A paper on the study features in the journal Cell Reports.

“Current drugs for anxiety,” says senior study author Mike Fainzilber, who is a professor in the biomolecular sciences department at the Weizmann Institute, “are limited in their efficacy or have undesirable side effects, which also limit their usefulness.”

He suggests that the findings could help to overcome these drawbacks.

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Anxiety and MeCP2

Most people experience anxiety now and again as part of everyday life. Anxiety disorders, however, are conditions in which the feelings of fear and uncertainty become overwhelming and do not go away. They typically last for 6 months or more.

The National Institutes of Health estimate that anxiety disorders affect around 1 in 5 people in the United States each year.

Having an anxiety disorder can also raise the risk of other illnesses such as heart disease, diabetes, and depression.

The study authors note that the gene MECP2 “is known to affect anxiety behaviors.”

Scientists have linked changes to MECP2 to a number of conditions. These include Rett syndrome and MeCP2 duplication syndrome, both of which feature anxiety among their symptoms.

All cells contain MeCP2, but the protein is “particularly abundant in brain cells.”

The protein regulates many genes that “play a role in normal brain function,” and particularly those that help to maintain synapses, or the connections between brain cells.

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Transport into the cell nucleus

The researchers became particularly interested in how MeCP2 enters the nerve cell nucleus, which contains the cell’s genes.

They turned their attention to a family of transporter proteins called importins, which Prof. Fainzilber’s laboratory has been investigating for more than 20 years.

For most of that time, he and his team have focused on the role of importins in nerve cells of the peripheral nervous system.

However, after first study author Dr. Nicolas Panayotis joined the group in 2012, they shifted their attention to cells of the central nervous system, which includes the brain and spinal cord.

Using genetically engineered mice, they identified importin alpha-5 as the transporter protein that helps MeCP2 to enter the brain cell nucleus.

In a series of behavioral experiments, they then saw that mice lacking importin alpha-5 did not display anxiety under stress compared to normal littermates or those lacking other importins.

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Drugs to target the mechanism already exist

Further investigation revealed that without importin alpha-5, MeCP2 could not enter the nucleus of brain cells that control anxiety.

This had a knock-on effect on an enzyme that produces the signaling molecule S1P. It was the reduction in S1P signaling that brought down the anxiety.

In the final part of the study, the team searched for molecules that might target the mechanism.

They found that there are already some drugs in use that alter S1P signaling. One of these is fingolimod, which doctors prescribe for the treatment of multiple sclerosis.

When the researchers treated unmodified mice with fingolimod, the animals displayed fewer anxiety behaviors, at a level similar to that of the modified mice that lacked importin alpha-5.

The finding could explain why a clinical trial of fingolimod for the treatment of multiple sclerosis reported that the drug appeared to have a “calming effect on patients.”

Prof. Fainzilber says that they have now identified a number of candidate drugs that target the mechanism that they identified.

Our findings have opened up a new direction for research into the mechanisms of anxiety.”

Dr. Nicolas Panayotis

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Medical News Today: How our body clocks can make or break our health

As our lifestyles become increasingly demanding, we build our lives around artificially divided days and nights that accommodate the need to work night shifts, stay up all night, or travel between continents. But this impacts our natural body clocks, with unwanted consequences.
tired person at their desk
New research homes in on how disruptions to our circadian rhythm make us vulnerable to disease.

If we tamper with our circadian rhythms — set by the body clocks that regulate all the automated processes that take place inside the body — we tamper with our health.

Our body clocks control metabolism, contributing to the proper functioning of every organ in our bodies.

However, if we regularly bypass our natural day to night cycles — by working through the night, traveling long-distance, or spending too much time looking at bright screens in the dark — our body clocks become disoriented and stop functioning correctly.

New research from the University of Southern California in Los Angeles, The Scripps Research Institute in La Jolla, CA, and Nagoya University in Japan identifies a key mechanism that links the dysregulation of circadian rhythms with a greater exposure to chronic diseases.

“Epidemiological studies are consistently revealing more and more connections between modern lifestyles and our internal biological clock, and when those two clash, it can lead to development of diseases such as obesity and breast cancer,” notes study author Steve Kay, Provost Professor of Neurology, Biomedical Engineering and Biological Sciences at the University of Southern California.

However, he adds, “This study goes beyond the epidemiology to explore the mechanisms of circadian disruption as a risk factor for certain diseases.”

The new study, which appears in PNAS, has identified a protein that plays a dual role in the context of the circadian rhythm, and which explains how disrupted body clocks can lead to disease.

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Disrupting a delicate balance

Kay and colleagues focused on HNF4A, a protein found in cell nuclei, which previous research suggested is involved in the early development of the liver, kidney, and large intestine.

When the researchers analyzed liver and colon cells taken from mouse and human tissue, they found that HNF4A interacts with the circadian clocks of these cells in complex ways. More specifically, HNF4A can block two other proteins — CLOCK and BMAL1 — that help regulate circadian rhythms in mammals.

“Inside the cell, the cogs of the clock are universal, but the hands of the clock are specific to each organ, so how the clock does its work in each cell is different,” explains Kay.

HNF4A, it turns out, responds to chemical signals within the cell and acts out on other proteins in accordance. This means that when this protein’s activity goes haywire, normal metabolic processes are also disrupted, leaving the organs more exposed to disease.

So, in the liver, we looked at tissue-specific proteins and found that HNF4A is tied to the circadian clock, is regulated by the clock and cycles with the clock and, in turn, regulates the clock. That’s the new finding here, and it’s a big jump forward.”

Steve Kay

As the study’s first author, Meng Qu, also explains, “Mutations in [the] HNF4A gene are known to contribute to a rare hereditary form of diabetes called MODY1, and its expression dysregulation has been closely linked to liver cancer, both with mechanisms we don’t fully understand.”

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“Our discovery suggests the clock disruption could be a potential mechanism and provides a bridge between circadian regulation and development of disease,” she adds.

Modern lifestyles often demand that we live by irregular rhythms, and the researchers warn that this can contribute to the disruption of sensitive mechanisms, including the ones in which proteins, such as HNF4A are involved.

“Humans are not evolved for night shifts, nighttime lights, and intercontinental travel. Modern-life challenges to our circadian system present a long-term threat to our health,” says Kay.

Discoveries such as the one highlighted in the current study can offer us a more detailed picture of how disrupted body clocks can affect health outcomes.

“Now we can see how HNF4A is a new chapter in a book that was mostly blank pages, so there’s a story beginning there as we fill in a huge blank spot,” Kay encourages.

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Medical News Today: What are neutrophils and what do they do?

Neutrophils are a type of white blood cell that helps heal damaged tissues and resolve infections. Neutrophil blood levels increase naturally in response to infections, injuries, and other types of stress. They may decrease in response to severe or chronic infections, drug treatments, and genetic conditions.

Neutrophils help prevent infections by blocking, disabling, digesting, or warding off invading particles and microorganisms. They also communicate with other cells to help them repair cells and mount a proper immune response.

The body produces neutrophils in the bone marrow, and they account for 55–70 percent of all white blood cells in the bloodstream. A normal overall white blood cell level in the bloodstream for an adult is somewhere between 4,500 and 11,000 per millimeters cubed (mm3).

When there is an infection or another source of inflammation in the body, special chemicals alert mature neutrophils, which then leave the bone marrow and travel through the bloodstream to the site in need.

Unlike some other cells or blood components, neutrophils can travel through junctions in the cells that line blood vessel walls and enter into tissues directly.

In this article, we look at the reasons for high or low neutrophil levels, how doctors can test these levels, and what normal neutrophil levels are for different groups.

Causes of high or low levels

There are many different reasons why a person may have higher or lower than normal levels of neutrophils in their blood.

High levels

Doctor taking blood samples from patient in hospital bed.
Neutrophils are a type of white blood cell.

Having an abnormally high level of neutrophils in the blood is known as neutrophilic leukocytosis, also known as neutrophilia.

Rises in neutrophil levels usually occur naturally due to infections or injuries. However, neutrophil blood levels may also increase in response to:

  • some medications, such as corticosteroids, beta-2-agonists, and epinephrine
  • some cancers
  • physical or emotional stress
  • surgery or accidents
  • smoking tobacco
  • pregnancy
  • obesity
  • genetic conditions, such as Down syndrome
  • surgical removal of the spleen

Some inflammatory conditions can increase neutrophil levels, including rheumatoid arthritis, inflammatory bowel disease, hepatitis, and vasculitis.

Low levels

An abnormally low blood level of neutrophils is a condition called neutropenia.

A drop in neutrophil blood levels typically occurs when the body uses immune cells faster than it produces them or the bone marrow is not producing them correctly.

An enlarged spleen may also cause a decrease in neutrophil levels because the spleen traps and destroys neutrophils and other blood cells.

Some conditions and procedures that cause the body to use neutrophils too quickly include:

  • severe or chronic bacterial infections
  • allergic disorders
  • certain drug treatments
  • autoimmune disorders

Some specific conditions, procedures, and drugs that interfere with neutrophil production include:

  • cancer
  • viral infections, such as influenza
  • bacteria infections, such as tuberculosis
  • myelofibrosis, a disorder that involves bone marrow scarring
  • vitamin B-12 deficiency
  • radiation therapy involving bone marrow
  • phenytoin and sulfa drugs
  • chemotherapy medications
  • toxins, such as benzenes and insecticides
  • aplastic anemia, when the bone marrow stops producing enough blood cells
  • severe congenital neutropenia, a group of disorders where neutrophils cannot mature
  • cyclic neutropenia, which causes cell levels to rise and fall
  • chronic benign neutropenia, which causes low cell levels for no apparent reason

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Lab technician examining sample of blood in vial
A laboratory specialist can evaluate a blood sample for white blood cell levels.

Doctors can identify changes in neutrophil levels from a blood test called a complete blood count (CBC) with differential, which identifies specific groups of white blood cells.

A doctor may order a CBC test when someone is experiencing a range of symptoms related to infection, chronic illness, and injury, such as fever, pain, and exhaustion. A nurse or technician will draw a small amount of blood from the arm and send it off for evaluation.

If the initial test shows a higher or lower number of white blood cells than normal, the doctor will likely repeat the test to confirm the results. If the initial results are confirmed, a doctor will perform a physical exam, ask questions about the person’s lifestyle, and review their medical history.

If there is no apparent reason for changes in white blood cell levels, the doctor will order a more specific test. Laboratory specialists will look for specific white blood cells, such as immature neutrophils called myeloblasts. During an infection or chronic illness, these cells emerge from the bone marrow and mature in the blood instead of the bone marrow.

If myeloblasts or other white blood cells appear in significant levels in the blood, the doctor will request a bone marrow sample.

Bone marrow collection involves inserting a long needle into part of the pelvis near the back of your hip. The procedure can be very painful, and a doctor will typically take the sample in a hospital setting with at least a local anesthetic.

Experts will examine the bone marrow sample to see if neutrophils and other blood cells are developing correctly and are in regular supply.

If the cause of the high or low neutrophil levels is still uncertain, the doctor will order other tests to try to pinpoint the cause of the changes, such as:

  • CT scans
  • blood cultures
  • urine sample analysis
  • a chest X-ray


Changes in neutrophil levels are often a sign of more significant changes in white blood cell levels.

The amount and proportion of white blood cells in the bloodstream change over time with age and other events, such as pregnancy. While everyone’s normal range is slightly different, some commonly used ranges include:

  • Newborn: 13,000 to 38,000 per mm3
  • Infant 2 weeks of age: 5,000 to 20,000 per mm3
  • Adult: 4,500 to 11,000 per mm3
  • Pregnant female (third trimester): 5,800 to 13,200 per mm3

In non-pregnant adults, a white blood cell blood count over 11,000 per mm3 is known as leukocytosis, which is an elevated white blood cell count. Neutrophilic leukocytosis occurs when a person has over 7,000 per mm3 mature neutrophils in their bloodstream.

The lower blood level limit for neutrophils in human blood is 1,500 per mm3. When a person’s levels of neutrophils are low, it is known as neutropenia. The lower the level of neutrophils circulating in the blood, the more severe neutropenia. Neutropenia levels are:

  • Mild neutropenia: 1,000 to 1,500 per mm3
  • Moderate neutropenia: 500 to 999 per mm3
  • Severe neutropenia: 200-499 per mm3
  • Very severe neutropenia: below 200 per mm3

Minor changes in neutrophil or white blood cell levels are typically nothing to worry about as long as they are temporary. A raised white blood cell count often means the body is responding to infection, injury, or stress.

Some people have naturally lower levels of white blood cells and neutrophils than other people due to a range of factors, including congenital conditions.

If neutrophil or white blood cell levels are significantly altered for no apparent reason or remain raised or lowered, a doctor will order more tests to determine the cause.

Severely high or low levels of white blood cells often require emergency care and monitoring. People with severe neutropenia will have an inadequate defense against infection.

People with severe neutrophilia typically have a life-threatening type of infection or other inflammatory illness that requires treatment, such as cancer.

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How to raise and lower levels

Nutritional yeast in a bowl
Nutritional yeast is a plant-based source of vitamin B-12.

The best way to correct abnormal neutrophil levels is to address and treat the underlying cause.

Antibiotics can treat bacterial infections, while antifungal medicine treats fungal infections. People can treat certain viral infections with medications that slow viral activity. Otherwise, supportive therapies, such as fluids and rest, may be part of the treatment plan.

People with altered neutrophil levels caused by medications or procedures may need to stop or adjust treatments.

People with chronic conditions that disrupt adequate neutrophil production or maturation may need to take drugs that allow the body to raise neutrophil production, such as:

  • colony-stimulating factors
  • corticosteroids
  • anti-thymocyte globulin
  • bone marrow or stem cell transplantation

People with severely low levels of neutrophils often require monitoring, antibiotic therapy, and hospitalization to reduce the risk of severe infection.

This period of intensive care helps keep people with weakened immune systems away from potentially harmful microorganisms. It also supports the body, giving it time to produce more white blood cells.

One of the causes of low neutrophil blood levels is a vitamin B-12 deficiency. Eating foods rich in B-12 may help improve low neutrophil blood levels. Examples of foods rich in vitamin B-12 include:

  • eggs
  • milk and other dairy products
  • meat
  • fish
  • poultry
  • many fortified breakfast cereals and bread products
  • fortified nutritional yeast products

To help reduce the risk of high or low neutrophil levels, people may want to try the following tips:

  • Try not to over-exercise or exercise beyond comfort levels.
  • Reduce stress levels and treat chronic or severe stress.
  • Seek medical attention for signs of infection, such as fever, weakness, fatigue, or pain, and treat infections exactly as prescribed.
  • Follow a healthful, balanced diet.
  • Eat enough protein.
  • Treat chronic conditions, such as genetic or inflammatory conditions, exactly as prescribed.

However, people with only minor or mild changes in their neutrophil blood levels often show no symptoms and do not require any treatment.


Having a healthy number of neutrophils in the blood and bone marrow is crucial to the correct working of the immune system.

When neutrophil levels are higher or lower than usual for more than a short period, a doctor will order several tests to work out the underlying cause. People with significantly altered neutrophil levels may also require hospitalization to prevent infection and treat life-threatening conditions.

Neutrophilia, when neutrophil levels that are higher than usual are often related to:

  • infection
  • illness
  • injury
  • physical or emotional stress
  • medication use
  • inflammatory conditions

Neutropenia, where neutrophil levels are lower than usual are often related to:

  • severe or chronic infections
  • cancer
  • drug therapy
  • vitamin deficiencies
  • genetic conditions

It is a good idea to have regular wellness checks at a doctor’s office to stay on top of health. Anyone with concerns about their neutrophil count or any medical condition should talk to their doctor who will be able to answer questions they may have.

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Medical News Today: Colorectal cancer: Loss of two genes may drive tumor formation

New research suggests that the loss of two genes may drive an aggressive form of colorectal cancer, and proposes a combination of two compounds that may halt tumor growth.
scientist looking at DNA structure
The reduced expression of two genes may explain the development of colon cancer.

According to to the American Cancer Society (ACS), colorectal cancer is the third most common form of cancer and the third leading cause of cancer death among both men and women in the United States.

Up to 35 percent of colorectal cancer cases evolve from so-called serrated polyps. Polyps are growths found inside the colon, which may or may not develop into cancer.

Colorectal cancers that arise from serrated polyps are often more difficult to treat, so identifying serrated colon cancers early on is crucial for improving a person’s outlook.

New research, published in the journal Immunity, suggests that losing two specific genes drives serrated polyps. The findings may lead to new biomarkers for this type of cancer.

Jorge Moscat, Ph.D., a director and professor in the Cancer Metabolism and Signaling Networks Program at Sanford Burnham Prebys (SBP) Medical Discovery Institute in La Jolla, CA, is the senior author of the paper.

The findings also shed light on why people with inflammatory bowel disease (IBD) are at a higher risk of developing colon cancer. IBD refers to conditions characterized by chronic inflammation of the digestive tract, such as Crohn’s disease and ulcerative colitis.

In the U.S., approximately 3 million people are living with IBD, according to recent estimates.

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Genes loss key in serrated colon cancer

Using a mouse model, Prof. Moscat and colleagues found that the loss of two genes caused the rodents to develop serrated colorectal cancer.

The two genes are responsible for encoding protein kinase C lambda/iota and protein kinase C zeta, respectively. An analysis of human tissue samples of serrated colorectal cancer also found a reduced expression of these two genes.

In the mice, the scientists also found that the loss of the two genes activated the tissue around the tumor and caused a protein called PD-L1 to infiltrate this tissue. Cancer cells often overexpress PD-L1 because the protein helps the cells evade the immune system.

Next, the researchers applied a compound — called a TGF-beta receptor inhibitor — that deactivated the tissue surrounding the tumor, together with a substance called anti-PD-L1 that reactivated the immune system.

This combined treatment shrunk the tumors and reduced their number.

The study’s senior author comments on the results, saying, “[T]he mouse model we created more closely mirrors the human disease, an important step that could help reveal more insights into this deadly cancer.”

Our findings identify both a promising combination treatment for serrated colorectal cancer and potential biomarkers that can identify this cancer subtype — both of which are urgently needed.”

Prof. Jorge Moscat

“It is very important that we understand how serrated colorectal cancer develops — especially as we know people with IBD are at risk for developing cancer,” Prof. Moscat continues.

“If we can identify the early mechanism of tumor initiation, we might be able to catch cancer early on in these patients.”

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IBD and cancer: Results may explain link

The findings may help explain why people with IBD are at a higher risk of developing colorectal cancer.

Prof. Moscat and colleagues had previously found that the expression of one of the two genes — the protein kinase C lambda/iota — is also reduced in people living with IBD.

But in the new study, the researchers also discovered that losing the second gene decreased the number of CD8+ immune cells, which led to the development of serrated colorectal cancer. The scientists refer to this loss of immune cells as a loss of “immune surveillance.”

“For people with IBD who already have reduced levels of protein kinase C lambda/iota, losing immune surveillance may be the ‘last straw’ in their line of defense against cancer,” explains study co-author Maria Diaz-Meco, Ph.D., who is also a professor in the Cancer Metabolism and Signaling Networks Program at SBP.

“This finding could help explain why these individuals carry an increased risk of cancer,” continues Prof. Diaz-Meco.

“Additionally, people with IBD are currently treated with immune-suppressing treatments. Because we show loss of immune surveillance drives colorectal cancer, this indicates we need to better understand the immune system’s involvement in [the] progression from IBD to colorectal cancer.”

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Medical News Today: Missed periods and ovarian cancer

A person may miss a period for a number of common reasons. Ovarian cancer is a rare cause of a missed period.

Ovarian cancer affects the ovaries, which are female reproductive organs that sit on either side of the uterus, or womb. This type of cancer may develop from various cell types in the ovaries or fallopian tubes. The most common type of ovarian cancer is an epithelial tumor called a serous carcinoma.

Ovarian cancer represents around 3 percent of cancer cases in women. In the United States, a female’s risk of developing ovarian cancer is around 1 in 78.

Understanding the symptoms of ovarian cancer can help a person get an early diagnosis. Missing a period can sometimes indicate ovarian cancer, but there are other more common symptoms.

In this article, we explore the link between ovarian cancer and missed periods. We also cover the symptoms and risk factors for this type of cancer and describe the outlook and when to see a doctor.

Can a missed period be a symptom of ovarian cancer?

woman looking at laptop
There can be various reasons for a missed period.

According to the American Cancer Society (ACS), ovarian cancer can affect a person’s menstrual periods. Changes may include bleeding that is heavier than usual or otherwise irregular. Missing a period can be one example.

If a person has ovarian cancer, missing a period can be an early sign. But there are many more common reasons for missing a period. These include:

What counts as a missed period?

To tell when a period is missed, it is important to understand the length of a menstrual cycle.

Typically, a person’s cycle is between 24 and 38 days. The exact length varies for everyone and may change by a few days each month.

Knowing what is normal for a person can help them spot irregular or missed periods.

Irregular periods occur when the menstrual cycle length varies by more than 7–9 days. A missed period is when no bleeding happens for a whole menstrual cycle.

Does a missed period affect ovarian cancer risk?

Missing a period does not cause ovarian cancer. However, there may be a link between missing periods and an increased risk of developing the disease.

A 2016 study revealed that women with irregular menstrual cycles may have a higher risk of developing ovarian cancer. The researchers found that this risk increased with age.

Women with irregular menstrual cycles were twice as likely to have developed ovarian cancer by age 70 than women with regular menstrual cycles.

Understanding why the risk of developing ovarian cancer may increase for people with irregular periods will require more research, as scientists have yet to find a causal link.

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Symptoms of ovarian cancer

Missing a period may be a symptom of ovarian cancer, but it is not the most common. According to the ACS, ovarian cancer typically causes:

  • pelvic or belly pain
  • the need to urinate frequently
  • a person to eat less or feel full quickly

Having these symptoms does not necessarily mean that a person has ovarian cancer. There is often a less serious cause.

If the symptoms result from ovarian cancer, they will occur often and feel severe.

If these symptoms occur regularly, see a doctor. This way, if there is a problem, the doctor can diagnose and treat it quickly.

Beyond changes in periods, other less common symptoms of ovarian cancer may include:

  • feeling extremely tired
  • having an upset stomach
  • being constipated
  • having a swollen belly
  • losing weight
  • having painful sex
  • experiencing back pain

Other risk factors

Factors that can increase a person’s risk of developing ovarian cancer include:

  • aging
  • having children after the age of 35 years
  • never carrying a pregnancy to term
  • being overweight or obese
  • having a family history of ovarian cancer, breast cancer, or colorectal cancer
  • using hormone therapy following menopause
  • having a family cancer syndrome
  • using fertility treatment, such as in vitro fertilization

When to see a doctor

woman having a blood test
A blood test will help eliminate other diagnoses.

The ACS state that a person should see a doctor if they experience common symptoms of ovarian cancer more than 12 times in a month.

Doctors will typically begin a diagnosis by asking about an individual’s symptoms and medical history. They may then examine the pelvis.

If a doctor suspects ovarian cancer, they may order one or more tests. These can include:

  • imaging tests, such as an ultrasound, MRI, CT scan, or X-ray
  • a laparoscopy or colonoscopy, which involve inserting a thin tube with a camera and light into a person’s body to check for signs of cancer
  • a biopsy, which involves taking a sample of the ovaries and analyzing it
  • blood tests to check overall health and rule out other conditions

If a person has ovarian cancer, an early diagnosis means that they can receive the necessary treatment as soon as possible.

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Doctors may recommend screening for people with an increased risk.

Screening may involve one or both of the following tests:

  • a transvaginal ultrasound, or TVUS
  • a cancer antigen, or CA-125, blood test

The CA-125 blood test looks for a protein present on ovarian cancer cells.

A 2015 study found that interpreting the results of a CA-125 blood test using a risk of ovarian cancer algorithm may help doctors diagnose a higher percentage of people with ovarian cancer. The researchers compared the algorithm with the results of the blood test alone.

Around 20 percent of people with ovarian cancer receive an early diagnosis. Often, this type of cancer causes no symptoms in the early stages.

At present, there is no recommended screening test for people who have no symptoms and no increased risk of ovarian cancer.


Receiving a diagnosis and treatment early may improve a person’s outlook.

Around 94 percent of people live longer than 5 years after an early diagnosis of ovarian cancer.


women on exercise bikes at gym
Overexercising can cause missed periods.

Missed periods are usually not a sign of a serious condition, but they can indicate:

  • low body weight
  • excessive exercise
  • pregnancy
  • stress
  • hormonal imbalance

However, less commonly, missing a period or having irregular periods may indicate ovarian cancer. More common symptoms of ovarian cancer include:

  • pelvic or belly pain
  • eating less
  • feeling full quickly
  • feeling the need to urinate often
  • urinating frequently

If a person has symptoms of ovarian cancer, they should see a doctor for an evaluation. The outlook for ovarian cancer can improve with early diagnosis and detection.

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Medical News Today: Red meat raises heart disease risk through gut bacteria

Scientists have uncovered further evidence of how a diet rich in red meat interacts with gut bacteria to raise the risk of heart disease.
two hands cutting red meat with knife and fork
A diet rich in red meat may affect heart disease risk by triggering the production of certain metabolites in the gut.

They found that people who ate red meat as their main source of protein for 1 month had levels of trimethylamine N-oxide (TMAO) that were two to three times higher than those in people who got their protein primarily from white meat or non-meat sources.

Gut bacteria produce TMAO as a byproduct when they feed on certain nutrients during digestion.

Previous studies have implicated high circulating levels of TMAO in the development of artery-blocking plaques and raised risk of heart-related conditions.

In the recent research, scientists at the Cleveland Clinic in Ohio uncovered two mechanisms through which a diet rich in red meat raises TMAO levels.

It appears that not only does frequent consumption of red meat enhance gut bacteria production of TMAO, but it also reduces elimination of the compound through the kidneys.

The European Heart Journal has published a report on the study and its findings.

“This is the first study of our knowledge,” says senior study author Dr. Stanley L. Hazen, who chairs the Department of Cellular and Molecular Medicine in the Cleveland Clinic’s Lerner Research Institute, “to show that the kidneys can change how effectively they expel different compounds depending on the diet that one eats — other than salts and water.”

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TMAO as a predictor of heart disease risk

In previous work, Dr. Hazen and his team had found that TMAO alters blood platelets to raise the risk of thrombosis, or blood clots.

Their work revealed that TMAO modifies calcium signaling in blood platelets. In addition, it showed that platelets respond differently to blood-clotting triggers when blood levels of TMAO are high.

The team proposed that the compound could be a powerful predictor of the risk of heart attack, stroke, and death — even when cholesterol and blood pressure levels are healthy.

Others have since replicated the findings and, like Dr. Hazen and his team, have continued to investigate TMAO and its impact on health.

Research from the University of Leicester in the United Kingdom, for example, demonstrated that people with acute heart failure fared worse if they had higher circulating levels of TMAO.

Clinical trials are also underway to test TMAO as a predictive marker of heart disease risk.

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Red meat diet compared with other diets

The recent study assigned 113 individuals to follow three tightly controlled diets in a random order for 4 weeks each with a “washout diet” preceding the changeover.

The diets differed according to their main source of protein. In the red meat diet, 12 percent of the daily calories came from lean red meat in the form of pork or beef, while in the white meat diet, these calories came from lean white poultry meat.

In the non-meat diet, 12 percent of the daily calorie intake came from “legumes, nuts, grains, [and] isoflavone-free soy products.”

In all three diets, protein accounted for 25 percent of the daily calories, and the remaining 13 percent of this protein came from “eggs, dairy, and vegetable sources.”

After 4 weeks on the red meat diet, “the majority of” the individuals had raised levels of TMAO in their blood and urine.

On average, compared with levels during the white meat and non-meat diets, blood levels of TMAO during the red meat diet were up to three times higher. For some individuals, the levels were 10 times higher. Urine samples revealed a similar pattern.

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Reduced kidney efficiency

The study also yielded an unexpected result. While on the red meat diet, the study participants’ kidneys were less efficient at expelling TMAO.

However, in the 4 weeks after ceasing the red meat diet, their blood and urine levels of TMAO fell.

Dr. Hazen says that the findings show that people can reduce their risk of heart-related problems by changing what they eat.

Gut production of TMAO was lower and kidney elimination was higher when the individuals followed the white meat or non-meat protein diet.

This suggests, says Dr. Hazen, that these types of diet are more healthful for the heart and body.

We know lifestyle factors are critical for cardiovascular health, and these findings build upon our previous research on TMAO’s link with heart disease.”

Dr. Stanley L. Hazen

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Medical News Today: How your imagination can help you overcome your fears

In your imagination, you can do anything. Riding a dragon? Piece of cake. Imagination is what fuels creativity and allows us to come up with innovative solutions. New research assessing brain scans shows that our imagination can also help us get rid of our anxieties and fears.
imagination concept image
Your imagination is a powerful tool that you could use to overcome your fears.

Our imagination is an incredibly useful tool. It can soothe us during difficult times and help us solve problems, create new things, and consider possible courses of action.

Some researchers have argued that our imagination, which gives us the ability to consider different scenarios, is at the core of what makes humans different from the rest of the animal kingdom.

Moreover, existing research has suggested that what we imagine can actually affect our minds and bodies in very concrete ways.

For instance, a study that the journal Psychological Science published in 2009 found that when we imagine doing something, our minds and bodies anticipate the imagined action as though it were a real action.

The results of another study, which featured in Current Biology in 2013, suggest that imagining that we hear certain sounds or see particular shapes can change how we perceive the world in real time.

New research by a team from the University of Colorado Boulder and the Icahn School of Medicine at Mount Sinai in New York, NY, now proves that what we imagine can seem just as real to our brains as actual experiences.

As the investigators explain in their study paper, which appears in the journal Neuron, we can harness the “magical powers” of our imagination to help us overcome persistent fears and anxiety disorders.

“This research confirms that imagination is a neurological reality that can impact our brains and bodies in ways that matter for our wellbeing,” says Prof. Tor Wager, co-senior author of the study.

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The power of what you imagine

When it comes to helping people address their phobias or anxiety disorders, psychologists may recommend “exposure therapy.” This approach aims to desensitize a person to stimuli that trigger a fear response by repeatedly exposing them to these stimuli in a completely safe environment.

This can help a person disassociate those stimuli from a sense of threat and impending negative consequences.

In the new study, the researchers used functional MRI to scan participants’ brains and assess brain activity both in real and imagined situations involving unpleasant triggers. The aim was to see whether and how imagination may help us discard negative associations.

“These novel findings bridge a long-standing gap between clinical practice and cognitive neuroscience,” notes the study’s lead author Marianne Cumella Reddan, who is a graduate student in the Department of Psychology and Neuroscience at the University of Colorado Boulder.

“This is the first neuroscience study to show that imagining a threat can actually alter the way it is represented in the brain,” she adds.

In the current study, the research team recruited 68 healthy participants, whom they conditioned to associate a particular sound with receiving an electric shock that was uncomfortable but not painful.

They then split the participants into three groups. To those in the first group, the researchers played the sound that the participants now associated with an unpleasant physical experience.

Those in the second group had to imagine hearing that same sound instead, while those in the third group — the controls — had to imagine pleasant sounds, such as the trills of birds and the pitter-patter of rain. None of the participants received any further electric shocks.

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Imagining a threat repeatedly can help

While the volunteers were either hearing the triggering sound, imagining it, or imagining a pleasant sound, the researchers assessed their brain activity using functional MRI. The team also measured their physiological responses by placing sensors on their skin.

The investigators found that brain activity was very similar in the participants who actually heard the threatening sound and those who only imagined hearing it.

In all of these volunteers, the auditory cortex (the brain region that processes sound), the nucleus accumbens (associated with learned fear), and the ventromedial prefrontal cortex (which signals exposure to risk) became active.

However, after the participants repeatedly heard or imagined hearing the triggering sound without receiving the expected electric shock, they stopped being afraid. The process had extinguished the association between that sound and an unpleasant experience. This phenomenon is known as “extinction.”

In the control group, in which the participants had imagined pleasant sounds only, other brain regions lit up in the functional MRI scans, and the negative association between the triggering sound and the electric shock never went away.

“Statistically, real and imagined exposure to the threat were not different at the whole brain level, and imagination worked just as well,” explains Reddan.

I think a lot of people assume that the way to reduce fear or negative emotion is to imagine something good. In fact, what might be more effective is exactly the opposite: imagining the threat, but without the negative consequences.”

Prof. Tor Wager

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You can ‘update’ bad memories

The researchers also suggest that, thanks to the power of imagination, we may even be able to “revise” and “update” memories that are unpleasant or unhelpful.

“If you have a memory that is no longer useful for you or is crippling you, you can use imagination to tap into it, change it, and re-consolidate it, updating the way you think about and experience something,” says Reddan.

However, just how vivid each of our imaginations is may affect the outcome of such experiments. Thus, the investigators explain, those with particularly vivid imaginations may benefit the most from “manipulating” unpleasant associations, while those with less active imaginations may not see much of a difference.

There is a real need for more research into the powers of imagination, say the researchers, but the current findings emphasize one thing — namely, that we should not underestimate the effect of what we imagine.

“Manage your imagination and what you permit yourself to imagine,” encourages Prof. Wager. “You can use imagination constructively to shape what your brain learns from experience,” he adds.

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