Archive for March 24th, 2009

COPING WITH PROBLEMS OF THE MENOPAUSE

Tuesday, March 24th, 2009

Emotional problems

Apart from the general measures outlined, such as keeping your interests going or taking up new ones and planning to do things together after the family has gone, simple measures should be tried first.

Some people take up yoga, others benefit from relaxation or exercise programmes. Group therapy helps others. Simply knowing that other women are going through this stage and have similar problems seems to help. Of course a good night’s sleep is essential, and if this is disturbed by flushes and sweats these must be treated. Hormones settle many, and these women describe a general feeling of well-being and ability to cope. This has been confirmed by scientific studies.Only after all these measures have been tried should tranquillisers and antidepressants be used.

Insomnia

Apart from hot flushes and sweats, some women have an altered sleep pattern due to the action of the hypothalamus. Of course if you are depressed this can also affect sleep patterns. Some women find it hard to get to sleep, others wake in the middle of the night. Too many women worry if they do not sleep through the night as they did in their youth, when they are not active enough during the day to warrant it. It is also important not to rush to the drug cupboard, as a few nights’ sleep disturbance will not hurt you. It is important to realise that this is usually only a temporary thing with the hormonal changes that are occurring, and it will settle. Simple measures as usual are the best. Hot milk, a brandy (one), relaxation, reading, etc. Oestrogen replacement almost always relieves insomnia when it first appears at the menopause by calming down the higher centres in the brain. This can be used if the insomnia persists after simple measures have been tried.

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MENOPAUSE PROBLEMS: FREQUENCY OF URINATION

Tuesday, March 24th, 2009

The neck of the bladder and the vagina develop from the same lump of tissue in the embryo. One group of cells divides into two to produce these two structures. It is not surprising, therefore, that when the vaginal tissues change and become less acid, the neck of the bladder does too. The tissues become thinner, less flexible, and more easily irritated, and infection becomes more common at this stage. Frequency of urination may become a symptom, and, in some cases, this is more marked after intercourse. Women may also develop what is known as an irritable bladder.

Oestrogens As with oestrogenisation of the vaginal tissues, infections are avoided, so too are urinary symptoms with this treatment. The tissues become stronger and healthier at the bladder outlet. Many patients describe an improvement in this problem with oestrogen treatment and sleep through the night when previously they had been frequently woken to empty their bladder. I treated one woman who, because of X-ray treatment for another complaint, had had her ovaries destroyed. Bladder problems had not been a presenting symptom. Her presenting symptoms had been of hot flushes, depression and loss of libido. We gave her implants of an oestrogen plus testosterone mixture and these fully relieved her symptoms. After several implants she reported to us that one of the ways she recognised her implant was running out was that she was woken three to four times a night to empty her bladder. One of the greatest boons she felt from the treatment she was receiving was that she had an uninterrupted nights sleep.

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HORMONE THERAPY

Tuesday, March 24th, 2009

Oestrogen may be given in three ways:

• by mouth (orally)

• as a cream or pessary applied locally

• by implants or pellets placed under the skin.

If the uterus is still present, progestogens at regular intervals are essential to stop the build-up in the lining of the uterus, with resultant bleeding or changes which might give rise to cancer of the uterus. Some believe that progestogens should be given in all cases.

The common oestrogens on the market at present are ethinyl-oestradiol (the synthetic oestrogen), conjugated equine oestrogen (Premarin), oestradiol valerate (Progynova), Piperazine oe-strone sulphate (Ogen) and Oestriol. Only ethinyloestradiol is available on the NHS. There are also several progestogens on the market, none of which are on the NHS list.

The government has not altered the NHS list for oestrogens since it was originally decided upon even though this therapy has gone ahead considerably. Complaints have been forwarded to the appropriate bodies from many authorities without results. It is something that women could lobby for through their local members.

Ethinyloestradiol in some instances causes nausea and headaches and is unsuitable for smokers or for women with high blood pressure as it increases thrombosis. It is the oestrogen in the oral contraceptive pill. All other oestrogens are very costly.

Progestogens are also costly and are not on the NHS listing for this purpose although it is recognised that they are necessary if oestrogen is to be taken safely. This is particularly hard on women from outer suburbs and the country areas who cannot attend public hospitals where these tablets are free.

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PREVENTIONS OF OSTEOPOROSIS

Tuesday, March 24th, 2009

Diet

Calcium and other minerals and vitamins must be taken by mouth to be absorbed and laid down in the bones Diet is therefore of importance. We should all eat foods rich in calcium. The body requirement is covered by 900 mL of milk per day (full or skim milk) or 600 ml of milk and 30 g of cheese. Foods rich in calcium are cheese, yoghurt, egg yolks, green vegetables and nuts – the ingredients of any good diet. If your diet is adequate, you will be obtaining some calcium from other foods, and 600 mL of milk is then sufficient.

It is a difficult task keeping in shape at this time, so milk, eggs, nuts and cheese may not be eaten in sufficient quantities, if at all.

To prevent bone loss, particularly in those women with a family history of osteoporosis, calcium supplements of about 1 g each day should be taken if the diet is deficient in milk, even before the menopause. Calcium should be taken only after consultation with your doctor as overdosage can produce problems elsewhere, for example the formation of kidney stones. Studies at both the Royal Women’s Hospital and Prince Henry’s Hospital in Melbourne showed that 75 per cent of women had insufficient calcium in their diet.

Alcohol and smoking

Bone loss is also accelerated by excessive alcohol consumption, and it is known that heavy smokers lose bone twice as rapidly as non-smoking menopausal women. This is said to apply also to men who smoke.

Prevention and treatment

It is up to you to cut down on alcohol and cigarettes, exercise well, and have a diet rich in calcium foods. This may need supplements if your diet is restricted for weight reduction or maintenance. Oestrogens are not universally prescribed for all women, as the benefits must be weighed against the side-effects.

It is important for women who have had an early menopause, either naturally occurring or artificially induced, to take oestrogens at least into their fifties (when they would normally have reached the menopause), in order to prevent bone loss.

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THE FACTS ABOUT BREAST CANCER

Tuesday, March 24th, 2009

Breast cancer is a common disease, and one in sixteen women in the population will develop it before she dies. It is very rare below thirty years of age. Breast feeding seems to be protective.

There appears to be an increased risk in those women who have:

• an early onset of menstruation

• a late first pregnancy

• a late menopause

• a family history of cancer of the breast.

It is important to stress that all women should practise breast self-examination.

Mammography Mammography is a special X-ray of the breasts, having a good pick-up rate for lumps in the breasts.

It is recommended for the high-risk group, that is those women with a family history of mother and sisters with breast cancer. These people should:

• practise breast self-examination monthly

• have regular checks by a specialist

• be examined by mammography if the specialist feels it is indicated.

Mammography is also useful in examining large, diffuse, lumpy breasts where it is difficult to detect lumps by means of breast self-examination. Some authorities are now advising all women over forty-five to have a mammography.

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