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We all react differently to problems at any time in our lives; there is an old saying that at the menopause we are what we are only more so, but this really only describes our reaction to any change or phase in our lives. For example some women notice pain more than others. It also depends on what else is going on at the same time.
It is suggested that women who have interesting and fulfilled lives notice the menopause less, but I do not find this in our clinic. I have patients who say they cannot carry on their busy involved lives with their hot flushes and emotional disturbances. Among these are a top accountant, an opera singer, and an executive in a business organisation. Some women, on the other hand, cannot do housework because of their menopausal symptoms. It all depends on your make up. There is no need to feel ashamed or apologetic, and there is no sense in not seeking help.
You may find that generally tidying up your physical habits is all that is needed. It is well known that tension, excess weight and alcohol consumption, to mention just a few examples, all increase the severity of some symptoms. Maybe you can adjust this yourself. Some believe in natural foods and increases in vitamins; others in hormone replacement. Find a sympathetic doctor you can talk to. I feel that if you know the facts, you can sort it out with him or her and in any case will be more relaxed about approaching and experiencing this phase in your life.
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Treatment of uncomfortable intercourse is to my mind one of the most important uses for oestrogen replacement. Women must be given oestrogen replacement long-term after the menopause if they are having painful intercourse and discomfort so severe it cannot be relieved by other measures. These women, from then on, will only get drier and drier if the discomfort is due to oestrogen lack, and the process will not be reversed unless treatment is given. Marriages have been ruined and family life disrupted when this simple treatment has been withheld. There is no doubt that this symptom is interrelated with libido after the menopause, but as explained later, other factors are also important.
In all the discussion about increased desire, or loss of it, there are two main points, that libido is maintained by regular sexual activity, and that sexual activity actually keeps the vagina more flexible. There is no doubt that sexual activity within a relationship gives a new meaning to it, and in most instances it is well worth maintaining. It is a fact that in both men and women, regular sexual activity in later life not only improves the performance but also the desire.
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As I have said already, if the uterus is removed periods cease, but, if the ovaries are left, hormones are still produced and menopausal symptoms should not occur. However, in patients attending our clinics, and it is reported elsewhere as well, a large number of hysterectomised patients do have menopausal symptoms earlier than expected. This is thought to be due to the fact that the blood supply to the ovaries is interfered with, and they atrophy or shrink following operation.
Oestrogen replacement after oophorectomy Unless it is con-traindicated, oestrogen therapy should be given after an oophorectomy. It is routinely done in most cases, particularly with younger women. Oestrogen replacement should be continued at least until after the woman would have normally had her menopause in her fifties as this prevents thinning of the bones or osteoporosis (see chapter 5).
7 thought I could not become menopausal if I had had a hysterectomy’ This is a common statement. If ovaries are present menopause will, in many cases, occur at about the same age as you would have it normally. If ovaries are removed it follows soon after operation.
Hysterectomies do not affect your sex life at all. If ovarian production is also interfered with but the symptoms are removed with replacement therapy, this should not affect your sexual life either.
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This is up to you, and may depend on the severity of your symptoms. As far as I am concerned I am neither of the group that says ‘It is best for everyone’ nor am I against it. I prescribe oestrogens for those whom, after full examination, I feel it will benefit, and for whom I believe it is safe. Oestrogen therapy should not be refused, nor should women worry about taking it, but like any therapy it should be used with caution and administered in the safest possible way. After all, this applies to any therapy.
If you are in doubt If you have symptoms, try replacement therapy. You can stop at any time; you will know in a short time if the symptoms are relieved and you feel better for it.
What is the safest possible way?
The safest course of replacement therapy is the method outlined in the guidelines of our clinic. We see patients six to twelve months after they are stabilised on treatment, examining their blood pressure and their breasts and looking for any untoward side-effects. We give them a full examination and pelvic examination yearly, and we do a smear test yearly for two normal smears, then every alternate year.
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SHOULD UNUSUAL BLEEDING BE REPORTED?
It is important to know about bleeding, when it is abnormal, and when to report to your doctor.
Heavy periods Around the menopause, women often experience heavy bleeding. This should not be ignored. In almost all cases it is due to hormonal changes, but, in a small number of cases, there may be something abnormal producing this, and a dilatation and curettage should be performed. This is not only for diagnosis, but is often curative.
Prolonged periods Any period that lasts longer than seven or eight days, or, if your periods are usually long, if there is a pronounced increase in length, should be reported.
Bleeding between periods This should be investigated; it may be due to a polyp or local build-up of tissues in the uterus or cervix, but it may be due to something more severe. It may also be due to oestrogen lack, due to an atrophic vagina, and in these cases it may also occur after intercourse. This should also be reported. Other bleeding that should be reported is bleeding that is more frequent, and bleeding that occurs twelve months after the last menstrual period.
Missed periods Although missed periods are very common during the menopause, you will probably want to consult your doctor to ensure you are not pregnant. If you are pregnant, and wish to carry on with the pregnancy, tests can be done to determine whether the baby has abnormalities. This should be considered as there is a relatively high degree of abnormality in babies of older women.
With oestrogen therapy, what bleeding should be reported?
1 Bleeding while the tablets are being taken unless progestogen tablets have been taken in the preceding week.
2 Any bleeding which is heavy or prolonged at any time, even if it is at an expected time, that is following progestogens.
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Through a few simple precautions, we can reduce risk of catching a cold or flu by approximately 80 per cent.
Most colds are caught by hand contact by first touching the hand or face of a person who has a cold or flu and then touching your own face, nose, mouth or eyes.
To minimize risk of catching a viral infection, avoid shaking hands or kissing anyone who has a cold or flu. Avoid using a phone if an infected person has just used it. The same applies to handling any object that may have just been touched by a cold or flu sufferer.
Above all, keep your fingers away from your face, nose, eyes and mouth. Even if you have just shaken hands with a cold sufferer, unless your hand actually touches your face you are unlikely to catch a cold.
Whenever you have any contact with a cold or flu sufferer, the best precaution is to wash your hands with hot rail seconds. Then wipe your hands with disposable paper tissue. Few viruses should remain on your hands after that.
The precaution is recommended after you have been with anyone who has a cold or flu, even if you didn’t actually touch them.
However, cold or flu viruses may also be transmitted through air. Hence it’s wisest to avoid contact with sneezers and coughers in crowded places. The most likely locales for catching airborne viruses are where you come into close contact with people, especially in elevators, trains, buses, planes, theaters, restaurants, schools, homes and offices.
Try to limit contact with sneezers and coughers in crowded places. Walk or drive to work if you can rather than go by bus or train. If you find yourself next to a sniffler on an elevator, consider getting off and taking die next elevator. If a friend or relative has a cold or flu, phone them rather than calling in person.
Should you be sneezed or coughed at from close quarters, blow your nose gently but steadily as soon as you can. Take care not to touch your face or nose with your hands. Five minutes later, blow your nose again. Always use throw-away tissues rather than handkerchiefs.
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Every single study to emerge from modem nutritional science has strongly indicated that our bodies rebel when we eat a diet high in fats, refined carbohydrates and animal protein. Our immune systems, and all other body systems and organs, fare best when we eat a vegetarian diet of complex carbohydrates augmented, if desired, by small amounts of fish, chicken or turkey without the skin, or by low-fat, unflavored yogurt or cottage cheese.
We should also aim to eat as many foods as possible in their primary state, meaning exactly as they exist in nature. Although grains, legumes and tubers may require light cooking, the closer they are to their original natural state, the more they contribute to our being disease-free.
While it helps to eat the 80-10-10 way during an infection, for maximum benefit we should try to follow this way of eating all of the time. Although no controlled study has been made to show that vegetarians have fewer colds, a number of carefully planned studies—including the Framingham study—have clearly demonstrated that vegetarians have a much lower incidence of heart disease, stroke, cancer, hypertension, diabetes, kidney disease, osteoporosis, gallstones and kidney stones, and infectious diseases than do men and women who eat refined carbohydrates and foods of animal origin. It would seem safe, therefore, to extend this list to include the common cold and influenza.
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A deficiency of B-complex components, especially Bl, B5, B6, B12, folic acid and PABA, have been clearly linked to impairment of the immune system in many animal species. Particularly when Bl, B5 and B6 are low in the bloodstream, immunocompetence has been found to fall off. A lack of vitamin Bl (thiamine) can also cause mild depression which has a detrimental effect on immunity. Vitamin B5 (pantothenic acid) has helped relieve many severe cases of hayfever; for this purpose, you should begin taking it one month before the hayfever season begins. And PABA is a B-complex component which acts as an anti-inflammatory agent.
It is not necessary to take large amounts of any single B vitamin. However, when intake of any single B vitamin is increased, the entire spectrum of the B complex should be increased proportionately. Hence B-vitamins are best taken in the form of a timed-release B-complex supplement containing the entire range of B-components.
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Because the respiratory tract is a series of cavities (sinuses, lungs etc.), connected by air passages, viruses can spread from the nose to the sinuses and throat and into the middle ear trachea, larynx, bronchial tubes and lungs. Secondary infections spreading to these locations can cause complications, some quite serious.
Laryngitis is a bacterial or viral infection of the larynx or voice box located at the top of the trachea (windpipe). The common cold virus is often the culprit, in which case medical treatment may be of little help. The infection causes inflammation of the mucous membranes of the larynx and vocal cords. Laryngitis is a common occurrence toward the end of a cold. Although fever and other flu-like symptoms may occur, the characteristic symptom is hoarseness which may be followed by loss of voice. When due to a viral infection, the voice returns as soon as the cold or flu ends. If voicelessness persists, a doctor should be consulted to determine the possible existence of a bacterial infection. Self-treatment includes staying at home and resting if possible, and bolstering immunocompetence by practicing the same therapies recommended for a cold.
Pneumonia is an umbrella term used to describe a variety of forms of inflammation of the lungs, ranging from a mild complication following an upper respiratory tract infection to a life-threatening disease. In all cases, the alveoli or gas exchange cells lining the lungs become infected, either by a virus or bacteria. Bacterial pneumonia is fairly easy to cure with antibiotics, bed rest and soothing cough medicines but recovery from viral pneumonia can take weeks and may require breathing oxygen.
It is interesting to note that most cases of pneumonia occur in people with low immunocompetence.
Symptoms of pneumonia include a fever which may rise to 105°F with abrupt chills and sweating, a painful cough, a sharp chest pain while breathing, breathing difficulty while resting, blood in the sputum, and a bluish tinge to the skin.
Pneumonia is a common complication following a bout with cold or flu but in persons with low immunocompetence it can be precipitated by a variety of causes ranging from physical accident and trauma to emotional stress resulting from divorce or loss of a loved one.
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Five hundred million colds beset Americans annually, causing a loss of 46 million workdays, and each winter week 13 percent of the population catches a fresh cold.
Yet the message of this book is that you can easily eliminate 80 percent of the risk that you will catch a cold this winter. And if you do catch cold, chances are good that you can recover completely not later than the evening of the second day.
Credence for these claims comes from the breathtaking succession of discoveries through which science has already unlocked the secrets of the common cold.
We have already learned the structure and design of cold and flu viruses and the entire process by which viruses enter the nasal passages and replicate themselves in cells lining the mucous membranes.
Because the common cold may be caused by one of over 200 different strains of rhinovirus, or similar virus, science has been unable to produce vaccine. A new form of alpha interferon spray, which may prevent up to forty percent of colds if used correctly, may soon be approved by the FDA. But despite some pioneering success with monoclonal antibodies and with a drug called WIN 51,711, medical science can still do little more than soothe the symptoms of the common cold.
Much of the newly discovered information about the common cold and flu has emerged as a by-product of cancer research. And most cancer research today is centered on immunology—the study of white blood cells (soldier cells) charged with defending the body against infection and disease.
Both the common cold and flu are caused by viruses which are recognized as foreign invaders and are identified as non-self by the body’s white blood cells. Cancer occurs when a body cell’s genes go berserk and become so genetically different that the cell, too, is identified as non-self by white blood cells.
Thus both cancer cells, and cold or flu viruses, invoke a similar response by the immune system.
Whether white blood cells can overcome and destroy a cancer cell depends on the overall competence of the body’s immune system. When immunocompetence is high, white blood cells are able to destroy each individual cancer cell that appears in the body before it can begin to clone into a tumor. When immunocompetence is low, a cancer cell may survive undetected and divide and grow into a tumor.
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