• - Adding progestogen to my oestrogen each month gives me a bad headache. What can I do about that?

    Headaches such as you describe are sometimes caused by fluid retention. It may be possible for you to reduce the dose of progestogen you are taking, and this possibility should be raised with your doctor.

    - I’ve had a hysterectomy and I’m taking Premarin pills. Are they likely to raise my blood pressure?

    No, Premarin should not have this effect. If your blood pressure is considered high, it should be treated with a medication for lowering blood pressure and you should continue with your oestrogen.

    - Does HRT have any effect on rheumatoid arthritis?

    A number of studies of oestrogens and rheumatoid arthritis have been published, with a mixed set of results. A 1986 study suggested a protective effect, while several more recent studies failed to confirm this. If there is an effect, we don’t yet know how long it lasts, whether some methods of delivering HRT to body tissues have a more beneficial effect on this condition than others, or what effect the addition of progestogen may have.

    - I’ve been having HRT to relieve severe hot flushes, and I’m wondering if the dosages are any different from those I need to protect me from osteoporosis or heart disease?

    This depends on the dosage you need to relieve your symptoms, and the individual way your body handles the hormones. If you are a young woman your symptoms are probably severe, and the dosage you are taking is likely to be ample for protecting your bones and heart. If you are older, your hormone dose may be low and your level of protection may be doubtful. To further complicate the situation, two women of the same age and with similar symptoms may handle the hormones somewhat differently, resulting in a greater level of protection for one or the other.

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  • Nearly a third of women aged forty-five to fifty-five who participated in the Melbourne Women’s Midlife Health Study complained of headaches. Given this prevalence, it is surprising how little research has been done on the relationship between headaches and hormones. For a small number of women, their first experience of headache seems to occur around the time of menopause, while for others they become less frequent. It is not known why this is so.

    If you begin to have severe headaches, including migraine and visual or sensory disturbance, at about the time you start on HRT, you should stop and have the problem investigated. If you already had a headache problem and are on HRT, the situation should be watched closely. Be sure to check that your doctor is prescribing a ‘natural’ rather than a ‘synthetic’ oestrogen and a form of progestogen that is least likely to make headaches worse. Changing the brand of oral oestrogen or changing from a pill to a patch or implant may also help.

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  • Women know that the menopause brings flushes and sweats, and generally cope if they are not too frequent. For some women, however, they happen so often and are so severe that they tend to dominate life. Amandine Dupin (better known as the French novelist George Sand) was forty-nine when she wrote in a private letter, dated 1853, ‘I am as well as I can be, given the crisis of my age. So far everything has taken place without grave consequence, but with sweats that I find overwhelming, and which are laughable because they are imaginary. I experience the phenomenon of believing that I am sweating fifteen or twenty times a day and night … I have both the heat and the fatigue. I wipe my face with a white handkerchief and it is laughable because I am not sweating at all. However, that makes me very tired.’

    As many women can testify, hot flushes and sweating episodes are far from imaginary, being intimately associated with fluxing levels in certain hormones and a rise in skin temperature by several degrees. Some women have accompanying nausea and palpitations. Flushes tend to be more prevalent in women who experience a rapid change in sex hormone levels, for example following a hysterectomy and bilateral salpingo-oophorectomy (that is, removal of both ovaries as well as the uterus and cervix), than in women who have a natural menopause. Flushes and sweats are also more likely in women who smoke, have a history of premenstrual syndrome (commonly abbreviated to PMS) or experience flushes and night sweats before menopause.

    The duration of these problems may also influence a woman’s decision to seek medical help. Flushes and sweats that disappear after a few months are easier to cope with than the same symptoms lasting for years. Studies show that flushes go on for about two years in most of the women affected. About 20 per cent have them for five or more years, and about 10 per cent are still having occasional flushes into their sixties. Descriptions of flushing and sweating episodes vary enormously. Some women tell us that their hot flushes are like a spray of hot oil that quickly passes. Others note that the sensation of heat is inevitably followed by shivering and cold sweats. Yet other descriptions of night sweats make them sound like clammy journeys through tropical rainforests without the beautiful surroundings, the aftermath of which is a need to change sheets and nightwear.

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  • According to Dr Derek Llewellyn-Jones, a Sydney obstetrician and gynaecologist and a prolific writer on health issues, at least a hundred symptoms have been attributed to the menopause, but only two can be related absolutely to the hormonal changes that are going on. They are hot flushes and vaginal dryness. Nonetheless women in the reproductive years can experience similar symptoms. In any given two-week period, for instance, one in ten women who are not menopausal experiences a hot flush.

    Irritability and moodiness are another good example of symptoms not confined to menopausal women, a point made by Dale Spender in the Sydney Morning Herald of 14 April 1993. ‘Now that we are all familiar with the psychological distress caused by unemployment,’ she said, ‘we can see that it is very similar to the so-called symptoms of menopausal women. [If they are] Denied a useful role and a sense of affirmation, the outcome is low self-esteem, depression and a sense of futility about the meaning of life. In the past we just confused menopause with “downsizing”.’ Not only do women of menopausal age sometimes experience feelings of scaled-down worth, they are also coping with the physical effects of fluxing hormones. Perhaps they might handle the situation better if they did not have to cope with these dual pressures simultaneously.

    SIGNS OF MENOPAUSE

    You may become aware that menopause is around the corner when some or all of the following signs show up:

    ? unpredictable menstrual bleeding that is sometimes very light and regular, at other times heavy and prolonged

    ? hot flushes and accompanying sweats

    ? bladder problems resulting in a need to urinate more frequently and troublesome urinary tract infections

    ? uncharacteristic irritability and mood swings

    ? short-term memory loss and difficulties with concentration

    ? sleeplessness and a generalised loss of zip

    ? a crawling sensation under the skin

    ? inexplicable weight gain and shifts in body fat distribution

    ? dryness of the vagina, making intercourse painful or less comfortable

    ? loss of libido

    ? less frequent appearance of the lubricative mucus from the cervix that indicates ovulation

    ? headaches, dizziness, heart palpitations

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  • Diarrhoea can be caused in many different ways. Infections are the most common cause – they tend to bring on an acute attack of diarrhoea that clears up of its own accord within a few days, as long as no further food is taken. Sometimes a temporary deficiency in the enzyme lactase follows on from the infection, and this can perpetuate the diarrhoea if milk is consumed. One form of infection that often goes unrecognized is infestation with the parasite Giardia. Overpopulation with the Candida yeast also produces diarrhoea, usually with other symptoms as well.

    Coeliac disease numbers diarrhoea among its symptoms, and in mild cases there may be few other signs. Crohn’s disease (pH3) and ulcerative colitis also result in diarrhoea, but they are serious conditions that pro- duce other symptoms as well. Psychosomatic illness can result in diarrhoea and intense stress can produce diarrhoea directly, by stimulating the sympathetic nervous system.

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  • Blankets should be light and porous. A duvet filled with down provides beautiful warmth but a heavy old eiderdown is uncomfortable. Woollen blankets are popular in many places, but in really bad weather anyone who feels the cold will probably need an additional duvet. On the other hand, those who become warm easily will find a light duvet is better in the summer, as opposed to a woollen blanket that keeps in the heat and is heavier. Our choice, then, depends upon our individual disposition and the time of year.

    In Guatemala, where two woollen blankets did not keep us warm enough during the cold nights, they gave us newspapers to use as insulation material between the blankets. True, it made us feel warmer but the constant rustling of the paper disturbed our sleep. Blankets made of pure wool, especially camel and angora, are excellent; for instance, they provide good insulation and create an electromagnetic field. Less favourable are synthetic fibres since many people, including those who suffer from rheumatism and arthritis, are susceptible to their unpleasant effect.

    Bed linen, too, has its place in providing the basis for healthy sleep and should be changed frequently. While in use, we should hang it out to air in the sun from time to time. Well-aired sheets will help to stimulate the skin pores so that they will function more efficiently. In fact, it is no idle imagination to feel a sense of pleasure and well-being between fresh sheets, but a clear sign that the frequent changing of bed linen makes for healthier sleeping.

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  • The peculiar connections between our psychological and physical life are reflected in the sentence ‘Breathing means life’. Again and again we find this concept discussed in journals and lecture halls and it may be of benefit from a scientific as well as a practical point of view if we examine and analyse what lies behind it.

    It is a fact that mental stress can have a potent effect on our general health. I have experienced that myself. If one’s profession requires one to be in the public eye, hostile people will engender malice and slander and make life difficult. Not everyone has a ‘thick skin’ and is able to shake off any and every kind of attack without feeling hurt, letting storm and the sound of ruin blow over him without upsetting his inner balance. You may think that you know your own strength and believe that your mental health is greater than it really is, but some problems can upset you so much that, in spite of having a healthy body, your organs begin to weaken, and may even give in and stop functioning. Anger, worry, disgust, disappointment and frustration are bad companions for health as they gnaw at our nerves and, eventually, the liver and pancreas become affected. This is what happened to me. My stomach began to play up in spite of my maintaining the best possible diet. Flatulence followed. Breathing became difficult and heart problems appeared. And, to top it all, appendicitis set in. A colleague examined me, confirming the diagnosis and expressing concern and fear. He advised me to have an operation.

    Instead, I fasted, drank only carrot juice, and took hot water treatments. I felt slight relief, but the condition did not really improve.

    What was I able to do to regain my resistance and get rid of the disturbances?

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  • Acidophil bacteria help to build up new intestinal flora in cases of dysbacteria and the connected destruction of useful bacteria. American researchers also claim that acidophil bacteria are important in the formation of vitamin Bn in the intestines due to intestinal biosynthesis.

    We know that vitamin B2 is important in the formation of red blood corpuscles, so we can conclude that the acidophilus is a tremendous help in cases of anaemia, as well as in the fight against pernicious anemia, in a supportive role. The intestinal flora is impaired when there is too much or too little gastric acid. Flatulence and poor digestion may occur. Acidophil bacteria have done much to relieve this condition as well as easing other problems too. For example, they are helpful in treating enteritis and similar inflammations of the intestines, and some causes of constipation. In view of these beneficial effects, it is recommended to take acidophilus two or three times a year for about a month on a regular basis. Any problems with the intestinal flora will then be rectified.

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  • Refined sugar, like refined flour, is a product of our civilisation, an unnatural ‘food’ and a contributory factor to ill health. We should keep away from anything that is detrimental to our health and reduces the nutritional value of our food. It is therefore obvious that denatured, refined foods are to be rejected. Unrefined cane sugar, on the other hand, contains various minerals, which are alkaline-forming and, at least, make some contribution to our health. Moreover, the allegation that it is treated with sulphur is untrue.

    The best sugar is, and always will be, that found in nature, that is, in fruits, either fresh or dried. Raisins, sultanas, dates and figs are ideal sources of natural sugar. Since it does not need to be digested, it is the best and quickest source of energy. In fact, it is completely wrong to believe that protein foods are the only energy source. And why? Just think of a bull and its tremendous power, yet it does not eat any kind of protein food at all.

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  • A sweet course or dessert has no place in a health diet because it encourages fermentation, that is, flatulence. If you cannot overcome your desire for fruit or some other naturally sweet food after a meal, postpone indulging in your fancy until at least 4 p.m. It is better, however, not to make a habit of such snacks between meals because it is always better to eat a little rather than a lot. A small amount of nutritious food goes a long way towards good health. Eating slowly and thorough insalivation will enable you to obtain the maximum value from whatever you eat; it prevents the pancreas from being overburdened and the formation of intestinal gases.

    For your midday meal, instead of soup, you may substitute vegetable juices or natural unsweetened yoghurt. Sugar does not go well with the lactic acid in yoghurt, as it causes fermentation. If you wish to increase your weight, by all means take soup, but if you tend to be overweight and wish to reduce your weight, you would do better to go without it.

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