We’re so pleased to announce that the featured guest for our October Fibroids Twitter chat will be Julia Mandeville, the Co-Founder of the Barbados Association of Endometriosis and PCOS.

Research suggests that 30% of women with fibroids have endometriosis  and in many cases this additional condition goes undiagnosed for many years. By raising awareness of endometriosis we can empower women with the information needed to facilitate an early diagnosis so that the most appropriate treatment is received without delay.

We are so delighted to have Julia as a guest so our followers can get a better understanding of endometriosis especially women with fibroids who may have unexplained symptoms which could be due to this condition.

Who is Julia Mandeville?

Julia Mandeville has been a science and health educator since 2010, gaining a B.Sc in Biology with Microbiology with honours from the University of the West Indies. She also holds a Master of Public Health with a specialization in Global Health from the University of Manchester.

Julia is the co-founder of the Barbados Association of Endometriosis and PCOS (BAEP) and is an emerging global health professional who has a particular interest in reproductive health rights, invisible chronic disease management, research and policy specifically as it relates to Caribbean women’s health.

Her personal struggle with Endometriosis and subsequent diagnosis was the catalyst that caused her to utilize her voice and become an advocate. She also has experience as a consultant and more recently has expanded her academic portfolio with certificates in gender, development and NGO management.

The Barbados Association of Endometriosis and PCOS

The BAEP was founded to address the knowledge gap as it pertains to these pelvic conditions and their impact in Barbados. It serves to advocate for the women in Barbadian society who are suffering due to lack of awareness and works to engage with major and relevant stakeholders to raise these conditions to a priority level in the public health community.

The BAEP is a non-governmental organization located in Barbados which has also collaborated with local and regional entities with similar mandates.

Join Us!

Join our #FibroidsChat to find out more about endometriosis and  the great work that BAEP is conducting to support Caribbean women affected by endometriosis and PCOS. To take part in the conversation find us on Twitter on 10th October at  3pm ( AST or  8pm GMT ) and use the hashtag #FibroidsChat.

Find Out More

You can find out more about the BAEP here  and you can follow the BAEP on social media:

Twitter: @endoandpcosbb
Facebook: https://www.facebook.com/EndoFacts/
Instagram: https://www.instagram.com/endoandpcosbb/?hl=en

To be kept up-to-date on this topic, please sign-up to receive our fibroids newsletter  and you can read a summary of our previous #FibroidsChats here

A study published in August 2018 by researchers at the George Mason University in the USA has demonstrated that exposure to chemicals in beauty and personal care products affect women’s reproductive hormones, and these effects may have an impact on women’s health.

What Did They Do?

In their study, researchers focused on chemicals commonly used in beauty and personal care products. These included bisphenol A (BPA), chlorophenols, benzophenones (a UV filter) and parabens (preservatives). They evaluated these chemicals in 143 women over two menstrual cycles. They also analysed the reproductive hormones oestradiol, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH).

The 143 women in this study were aged 18 to 44 years old, had no known chronic health conditions and did not use birth control.

Dr Anna Pollack, lead researcher, on this study noted that:

“This study is the first to examine mixtures of chemicals that are widely used in personal care products in relation to hormones in healthy, reproductive-age women, using multiple measures of exposure across the menstrual cycle, which improved upon research that relied on one or two measures of chemicals”

This is an important point to note as measuring mixtures of chemicals better reflects the real-world situation where women will be exposed to several chemicals.

What Did They Find?

The study found that exposure to these chemicals, even low-level exposure to mixtures of these chemicals affected participants’ reproductive hormones.  Specifically, they found that:

• BPA, chlorophenols, UV filters and parabens were linked with reproductive hormones
• Parabens were associated with an increase in oestradiol
• Phenol and UV filters were linked to a decrease in oestradiol, FSH and LH

What Does This Mean?

The results of this study are interesting as changes in reproductive hormones have been linked to a number of health conditions such as fibroids, breast cancer and cardiovascular disease.  Therefore, care must be taken when selecting beauty and personal care products.

Researchers noted that:

“We have early indicators that chemicals such as parabens may increase oestrogen levels. If this finding is confirmed by additional research, it could have implications for oestrogen dependent diseases such as breast cancer.” Dr Anna Pollack

Researchers therefore concluded that:

“What we should take away from this study is that we may need to be careful about the chemicals in the beauty and personal care products we use.”

You May Also Be Interested in These Stories

• My Haircare Nightmare: Help Us Start A Revolution
• More Concerning Research on Black Hair Products
• Latest Research on Hair Dyes, Relaxers and Breast Cancer
• Black Women, Relaxers and Fibroids
• Black Hair Products: We Want to Hear from You!

You can read the research paper describing this study here

We like listening to the podcast The Nod. It’s a fun, witty and insightful look at black American culture. The hosts have a great way of exploring important topics and unearthing interesting untold stories.

In their episode released on 10th September 2018, ‘Bleeding and Healing‘, host Brittany Luse focuses on a common women’s health issue (we won’t tell you which one, so we don’t spoil the episode for you), that is overlooked and disproportionately affects black women.

This health issue is one that we have explored over the past couple of years and this episode of The Nod does a great job at raising awareness and highlighting some of the keys challenges such as:

• The extent to which women normalise pain
• Not having a clear idea of what is normal and abnormal when it comes to period pain and menstrual bleeding
• The lack of awareness of women’s health issues
• The length of time it takes for women to be diagnosed
• The confusion that can exist when it comes to making treatment decisions
• The challenges of finding not just a good doctor, but one black women feel comfortable with

This episode provides some good food for thought. You can listen to it here and below is the description of the episode from The Nod team.

“For years, KalaLea experiences painful periods that keep her in bed for days at a time. As she tries to figure out what’s happening to her body, she discovers that she has a condition that disproportionately affects Black women. This is the story of how KalaLea listened closely to her own body and made her doctors listen, too.

“This week’s story comes from the Bodies podcast. After the show, KalaLea joins Brittany in the studio to share advice on how to better advocate for your own wellness.” 

Have you listened to  the ‘Bleeding and Healing’ episode of The Nod? We’d love to hear what you think. Please leave a comment in the comments section below or send us an email.

Disclosure: this post contains an affiliate link. Find out more here

We just finished reading Flow Fighter: How I Kicked My Fibroids and Heavy Periods to the Curb by Holly Bridges. We thought this was a very insightful and informative book that not only explores the personal experience of the author but that of other women, young and old, with fibroids, endometriosis and heavy menstrual bleeding. In this book we also hear from gynaecologists, young doctors, women’s health advocates and sexual health experts and through all these perspectives readers are given a comprehensive view of the fibroids experience.

We were also taken on an educational journey with the author having conducted extensive research into fibroids, other gynaecological conditions and heavy menstrual bleeding. The book explains, in detail, the latest warnings from the FDA and Health Canada on laparoscopic power morcellators and the drug Esmya. Helpfully and impressively we’re provided with:

• Timelines that provide context and background to these warnings,
• Letters, quotes, summaries of research, recommendations and reports from all interested parties on both sides of the argument of these warnings – the FDA, Health Canada, gynaecologists and other government agencies

The above facts were interspersed with commentary from the author which gave us some good background into both issues.

Our educational journey continued with a reminder of the structure and function of the women’s reproductive system, what fibroids are and what constitutes heavy menstrual bleeding.  The book covered all the treatment options for fibroids and what their pros and cons are. The author also reflects on the injustices that exist with respect to women’s health where the lack of focus on conditions like fibroids mean:

• There are still major gaps in research;
• There is a significant delay in the diagnosis of many women leading to years of unnecessary suffering;
• There is no clear understanding of the cause of fibroids and the best approaches to treat women;
• We have a healthcare system that is not patient-centred leading to women feeling isolated and confused.

Author Holly Bridges also discusses the reasons why hysterectomies are so common, why doctors recommend invasive treatments over non-invasive approaches, and why this needs to change.

At the core of this book is the message that women need to be empowered with all the information they need to make an informed decision about their treatment.

The format of the book is useful with many chapters ending with a list of takeaway messages. In addition, the author, throughout the book, refers readers to useful resources. These include books, research papers, videos and websites.

The book ends with a chapter entitled ‘Empowering Our Daughters’ which we thought was very important section because there is a need to ensure that the generations of women who follow have a better experience.

The only topic that we felt was missing was a discussion on the impact of diet, exercise and environmental toxins on fibroids. This was touched on very briefly and there was recognition at the end of the book that this is an area that requires some attention and the author will be exploring this in the future.

This was a very interesting and informative book and we recommend it to anyone wanting to learn more about the experience of women with fibroids and how we can move forward and ensure that women get the best care possible.

You Can Claim A Discount on this Book

We’re delighted to say that Holly Bridges is offering a 20% discount on her book to all our blog readers. To claim your discount, visit her website and use the discount code LakeHealth at check out.

Also, the first few people who register to attend our fibroids self-care webinar in October will be entered into a giveaway and one lucky person will win a copy of the book.

Have You Read Flow Fighter?

Have you read this book? We’d love to hear your thoughts. Please leave them in the comments section below or send us an email

Disclosure: this post contains an affiliate link. Find out more here

We are delighted to let you know that registration for our Fibroids Self-Care Webinar Series is now open! Our series starts on Saturday 27th October at 11am AST/4pm GMT with a session led by Le’Nise Brothers, a Registered Nutritional Therapist and the Founder of Eat Love Move.

Le’Nise will deliver a webinar on Fibroids, Diet and Hormones giving attendees the opportunity to learn about the role that hormones play in the development of fibroids and how simple changes to your diet may improve symptoms.

Discounted Early Bird Tickets Are Now Available

Early bird tickets for this webinar are now available and are just $10 (about £8) and you can book your tickets on Eventbrite 

We Have A Special Giveaway Just For You

We’re pleased to let you know that the first 10 people who register for this webinar will be entered into a giveaway and one lucky person will win a copy of the book ‘Flow Fighters – How I Kicked My Fibroids and Heavy Periods to the Curb’ by Holly Bridges.

We’re also delighted to have formed a partnership with OH Services who will be launching their ‘Emotional Impact of Fibroids’ online course in November 2018.  The first 10 people to register for our webinar on 27th October 2018 can claim a £5 discount on the cost of the OH Services course.

Other Webinars in this Series

Other webinars in the series will include:

Session 2: Deciding on the Best Treatment For You, Apryll Chase, Consultant Gynaecologist, 5th December 2018

Session 3: The Importance of Exercise, Relaxation and Me-Time, Candice Bryan, Founder and CEO, Noire Wellness, 23rd February 2019

Session 4: Hair and Body Care for Women With Fibroids, Rachael and Jocelyn, Founders of Afrocenchix, April 2019 (To be confirmed)

Session 5: Dealing with the Emotional Impact of Fibroids, Olivia Haltman, Founder, OH Services, June 2019

Session 6: Our Fibroids Stories – A Time to Share, August 2019

More Information 

We hope that you’ll join us on 27th October for this really interesting online event and if you have any questions, please don’t hesitate to get in touch with us at events@lakehealthandwellbeing.com or visit our Eventbrite page

Disclosure: this post contains an affiliate link. Find out more here

We’re delighted to announce that our July Fibroids Twitter Chat will be with Jenny Rosenberg on 25th July 2018 at 2pm EST (that’s 7pm GMT, or 2pm AST).

Jenny Rosenberg is the Executive Director of CARE About Fibroids and is an internationally recognized leader in health care policy and strategic communications. Mrs. Rosenberg served for more than a decade in senior-level policy and communications positions in the Obama Administration and Congress.

Previously, Mrs. Rosenberg was Director of Communications to former U.S. Surgeon General Dr. Regina Benjamin and former U.S. Assistant Secretary for Health Dr. Howard Koh. ​Her broad experience as a regulator, policymaker and communications expert brings a comprehensive, multifaceted approach to enhancing public awareness over critical public health issues.

CARE About Fibroids is a Washington, DC-based non-profit whose mission is to elevate uterine fibroids as a women’s health issue and drive change. Bringing together many of the nation’s most respected women’s health advocacy and policy-focused organizations to advance solutions, CARE About Fibroids is a catalyst for increased awareness, research and education about uterine fibroids, leading to earlier diagnosis and improved treatment.

Join our #FibroidsChat to find out more about the great work that CARE About Fibrioids is conducting. To take part in the conversation find us on Twitter on 25th July at  2pm (US EST and 7pmGMT ) and use the hashtag #FibroidsChat.

You can find out more about CARE About Fibroids here: www.careaboutfibroids.org and you can follow CARE About Fibroids on social media:

Twitter: @CAREAbtFibroids

Facebook: @CareAboutFibroids

Are you interested in this topic? Then please do sign up to our fibroids mailing list here

We are so delighted to announce that we will be launching our fibroids self-care webinar series in the autumn. The aim of this series is to empower women affected by fibroids with information, knowledge and practical tips to take action to improve their health and wellbeing.

The series will include four webinars led by experts in the field of gynaecology, nutrition, exercise and mental health with a fifth session being an Our Stories session. In this final session attendees will hear from women who have conquered fibroids and will have the opportunity, if they wish, to share their own experiences. We will also explore challenges, useful tips and discuss solutions. Lake Health and Wellbeing will use this session to listen, understand the current experience of women with fibroids and work with attendees to explore how we can best support women with fibroids.

If you have fibroids, this webinar series will be perfect for you. It will give you the opportunity to meet other women with fibroids and provide you with access to experts in the field, all from the comfort of your home. This is not to be missed.

The webinars will be held every two months and there will be a small charge.

For more information and to register your interest, please contact us on events@lakehealthandwellbeing.com  or you can sign up to our fibroids mailing list here

More details will follow very soon.

Disclosure: this post contains an affiliate link. Find out more here

In today’s blog post we hear from Silvia who shares her experience with fibroids and explains why she started her blog, Life With Fibroids.

Well, let’s start off with a little bit about me. My name is Silvia and I am married to an amazing man who is so supportive and have an adorable dog who from time to time drives me nuts, but that is okay because I adore him.  I have fibroids and have been living with them for two years and have come to a place in my life where I want to share my story and my personal opinions and connect with others and learn about their stories as well.

I was diagnosed with Uterine Fibroids two years ago officially but have lived with them for just about 6 years now and since then I have done a lot of research but there is still so much more to do, so in no way am I saying I am an expert and I am not a doctor.  I decided to start my website, Life with Fibroids,  to create a space where women of all ages, creeds, backgrounds, religions, and parts of the world could come together and know that having fibroids does not mean that you are alone. Although fibroids is very common it is crazy to think that it is not a very talked about subject for most women and there is really no place to connect with others and ask how they are living with it and going through life with this. I was diagnosed with Uterine Fibroids two ago and they do affect my life they make me have the worst menstrual cycle of my life for example I have more bleeding and the first couple of days is so painful and the cramps sometimes can drop me to my knees. It hurts so much let me just say.

I guess, for me at least, that is the biggest inconvenience and it is so crazy to think that they can develop like they did for me because of the fact that your body can produce too much oestrogen and they can grow over time as well and can cause other problems like infertility if they block the Fallopian tubes and get in the way of implantation but to know that it is on a case by case situation and if you come to find out  that you have them and are worried about that then I would definitely set up an appointment with your doctor and get your situation checked. I did and thankfully they are not going to stop me from getting pregnant but I think for the best option since they have gotten bigger is to get them removed before we try for a baby again since I have experienced a miscarriage due to fibroids and want to avoid any further complications due to fibroids, so that is another reason for me to write this post and try to reach out to those who are in the same situation and be an outstretched hand and let others know you are not alone and I am here for you. I guess I just want to help people share and get connected and help support each other because there are lots of stories like mine but there are also lots of stories that end up with a happy mommy and a happy baby, so like I said it is case by case and if I can help even one person then I think that writing this post and creating my blog, Life with Fibroids, is worth it.

Now let’s get a few things clear about fibroids first:

1. Fibroids are not cancerous and from what I have come to learn not life threatening, so you can take that stress off your mind right now.
2. What my doctor has come to teach me is that for every woman’s fibroids are different and can affect them in different ways and with fibroids especially the kind that I have which is Uterine Fibroids is always a case by case situation so in no way am I saying that I know everything about you and your situation so please feel free to write about your story and connect with others.
3. Fibroids can happen anywhere in the body but the most common fibroid I have come to read about is Uterine Fibroids which is what I have.
4. Even though many women have fibroids they can go their entire lives without knowing it due to having no symptoms and doctors not having any indication to look for them.
5. Women who do have them and do have active symptoms can have a variety and cannot have their daily lives affected in any way and then there is the other side of the coin where women have their everyday life come to a standstill and cannot function and then of course there is the middle ground where you have good and bad days but nothing too drastic, which for the most part is where I fall, well for the most part anyway.
6. My final point on this never-ending list is that for every woman with this diagnosis there is a story and it is different and each and everyone is valuable and important.

So with all that I have said again I just want to say that I created my blog, Life with Fibroids, as a place to connect and share your individual stories and remember that you are not alone and you are one of a kind and that you and I and everyone else living and not living with this is beautiful and amazing. Please feel free to visit my blog, share your stories and help me to connect with others from all over. Thanks for taking the time to read my post and even though I am not the most talented writer I want to share my story and hope that it can help at least one person out there. Thank you again for visiting and taking the time to read my post. At Life with Fibroids I do my best to keep everyone up to date on what is happening with me and my fibroids and try my best to keep it active and hopefully on-going. Have an awesome day and you rock!

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Lake Health and Wellbeing  would like to say a big thank you to Silvia for sharing her experience with fibroids, we hope that through her experience you have gained some useful insight into this condition. You can find out more about Silvia at Life With Fibroids

If you have any questions or comments please do leave these in the comments section below. 

Disclosure: this post contains an affiliate link. Find out more here

We first heard about Eat Love Move on the Secret Birds Podcast a couple of months ago when founder Le’Nise Brothers was interviewed about health, hormones and barriers.  We were really impressed with all the great work that Le’Nise is doing and it also piqued our interest because of the work we’ve been doing on fibroids, an area that Le’Nise focuses on too. We felt the services offered by Eat Love Move would be of interest to you, our readers, so in today’s blog we introduce you to their services.

Who Is Eat Love Move?

Eat Love Move is a business that focuses on women’s health and offers personalised hormonal health programmes and workshops. At the helm of the company is Le’Nise Brothers, a registered naturopathic Nutritional Therapist who specialises in women’s health, anxiety, depression and weight loss.

As a nutrition and wellbeing coach for women, Le’Nise’s mission is to help women understand and embrace their hormones and menstrual cycle and thus much of her work focuses on women who struggle with low energy, sugar cravings and hormonal issues such as PMS, PCOS, endometriosis, heavy & painful periods, fibroids, perimenopause and menopause.

“I’ve had a life-long interest in food – eating it, cooking it and sharing it. I slowly started to make the connection between what I was eating and how I was feeling and used diet and lifestyle changes to improve my anxiety, depression and irritable bowel syndrome.”  – Le’Nise Brothers

Le’Nise firmly believes in the power of food and she takes the time to understand her clients, their lifestyle and goals, and then designs nutrition and lifestyle programmes that are tailored to the individual.

Their Services

Eat Love Move’s services fall into three categories:

• Personalised Health Programmes
• Hormone Health Programmes
• Workshops and Talks

Personalised Health Programmes – these are a minimum of 8 weeks long and are for women who have symptoms or health issues, are concerned about their family’s medical history or have been advised by their doctor to improve their diet.  A typical personalised health programme consists of the following:

• Initial personal consultation including an in-depth health and lifestyle assessment
• Personalised nutrition advice and supplement plan
• Current medication and nutrient interaction evaluation, if applicable
• Recommendations of clinical tests and interpretation, if applicable
• Follow up consultations – face to face, skype, telephone
• Mini progress review calls
• Email support
• Personalised menu planning and recipes

Hormone Health Programmes – Eat Love Move offers three programmes:

1. Period Helper – this is a personalised programme that helps women with their periods and menstrual cycle so they enjoy life with no PMS or pain (yay!)
2. Hormone Helper – this programme teaches women how to manage their hormones and stress, and how food can bring things back into balance.
3. Menopause Helper – teaches women how to support their hormones and get a sense of balance so they feel better as they go into perimenopause and menopause

Workshops and Talks

Le’Nise is passionate about helping women learn more about how they can improve their health and wellbeing and regularly facilitates workshops and delivers talks covering a range of topics including meal planning, wellbeing in the workplace, self-care and hormone health.

More Information

For more information and to book a free 20 minute health and wellbeing review you can email hello@eatlovemove.com or visit their website

Eat Love Move offers Skype and FaceTime consultations so you can access their services from anywhere in the world, or if you’re based in London you can find Le’Nise at the Onebody Clinic in Chiswick on Tuesdays and Saturdays from 9 – 11am

Alternatively, you can join Eat Love Move’s private Facebook group, Embrace Your Hormones. It’s a private and positive space for women to ask questions about their hormones and menstrual cycle and get evidence-based information and support.

Disclosure: this post contains an affiliate link. Find out more here

Today we tackle a question that we are asked quite regularly at our fibroids events: ‘Is there a link between fibroids and endometriosis?’

To answer this question, we’re going to look at what research tells us, but first let’s start with a bit of background on endometriosis. You can find out about fibroids on our fibroids page here

What is Endometriosis?

Endometriosis occurs when cells similar to those that line a woman’s womb are found in other parts of the body like the ovaries, fallopian tubes, bladder and stomach. The problem with this is that the cells that line the womb have a specific function which is only appropriate in the womb. The cells that line the womb build up, break down and bleed every month during our period. In the womb the blood has an escape route (the vagina), but in endometriosis the blood from the womb-like cells don’t have an escape route, and this can cause pain, inflammation and scarring.

Endometriosis is a long-term condition that affects millions of women worldwide causing a range of symptoms, such as heavy and painful periods, back pain, constipation, infertility and more. Thus, it has a significant impact on a woman’s quality of life.

Is there a link between fibroids and endometriosis?

When we look at research that has been conducted in this area, there does seem to be a link between fibroids and endometriosis. Firstly, several studies have found that many women with fibroids also have endometriosis, but just how common it is to have both fibroids and endometriosis isn’t clear as it has varied between studies. For example, a study carried out in the US by a team in Stanford in 2010 found that 86% of patients with fibroids also had endometriosis, whilst in 1994 a team in Italy found that just 12% of women with fibroids had endometriosis. Furthermore, three other studies found that 87%, 21% and 28% of women with fibroids also had endometriosis.  So, it does vary from there being a very strong link (87%) to a relatively weak, but significant link (12%).

When we look at the biology of fibroids and endometriosis there is evidence of a link between these two conditions. It has been reported that fibroids and endometriosis have common biological abnormalities that contribute to the development of both conditions. Namely these are defects in molecules called 17B-hydroxysteroid dehydrogenase (involved in hormone regulation) and aromatase (involved in the production of oestrogen). Related to this it is thought that women with fibroids and/or endometriosis tend to have a hormone imbalance having excess amounts of oestrogen in the body which, in both conditions, causes growth of the abnormal cells.

Why is it important to know about this link?

It’s important for patients and doctors to be aware of the link between fibroids and endometriosis so patients can receive the most appropriate treatment. If there is no awareness that women with fibroids are likely to also have endometriosis, patients diagnosed fibroids will be treated for just their fibroids and their symptoms may persist which the doctor and patient may think is due to the treatment being ineffective, but the persistent symptoms could be due to undiagnosed endometriosis. Researchers from the Stanford Study therefore recommend that doctors explore whether their fibroids patients also have endometriosis. Their study did identify helpful clues to identify whether a patient with fibroids may have endometriosis. They found that women who were diagnosed fibroids were more likely to have endometriosis if they:

• Had pelvic pain that was disproportionate to the size of their fibroids
• Were infertile

Therefore a good starting point for doctors and patients wanting to explain persistent symptoms after fibroids treatment is to explore whether the two symptoms above are present as this could mean the patient has endometriosis. If we can pinpoint these patients early then steps can be taken to alleviate their symptoms and thus improve their quality of life.

More Information

For more information about endometriosis you can visit Endometriosis UK’s website and for more information about the link between fibroids and endometriosis you can check out the references below.

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References

1. Huang J.  et al. (2010). Coexistence of endometriosis in women with symptomatic leiomyomas. Fertil Steril, Volume 94(2), p 720.
2. Nezhat C. et al. (2016). Strong Association Between Endometriosis and Symptomatic Leiomyomas. JSLS, Volume 20 (3).
3. Maclaran K., Agarwal N. and Odejinmi. (2014). Co-existence of uterine myomas and endometriosis in women undergoing myomectomy: risk factors and surgical implications. J Minim Invasive Gynecol, Volume 21 (6), p 1086.
4. Tanmahasamut P., Noothong S., Sanga–Areekul N., Silprasit K. and Dangrat C. (2014). Prevalence of endometriosis in women undergoing surgery for benign gynecologic diseases. J Med Assoc Thai, Volume 97 (2), p147.

Disclosure: this post contains an affiliate link