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Summary of Women’s Health Talk to PPG on 22nd June 2016

By Dr Karen McGorry

• Screening is important. Proven to save lives. Cervical and Breast screening stops at 65 yrs but if you have never had a smear you can still have one. You can also request further mammograms by contacting the service direct [in your last letter or your GP Surgery should have the number]. Remember most cases of breast cancer are detected by the patient so be Breast Aware.

• Around the menopause time physiological changes can occur to the woman’s body: rising cholesterol, glucose, weight [ so increasing risk of hypertension, diabetes, heart attacks and strokes] and risk of osteoporosis. So a healthy LIFESTYLE is very important to counteract these changes, especially as one-third of the woman’s life is in the menopause! REGULAR exercise, stop smoking, good weight [not under or over],balanced diet, alcohol within recommended limits. Many of these recommendations can also reduce your risk of cancer, eg. Breast, cervical, womb, ovarian.

• Average age of Menopause is 51 yrs but the few years leading up to this time can be particularly difficult for the woman, when hormones are fluctuating greatly. Symptoms are variable, including flushes, night sweats, general aching, poor memory, low mood, low libido, anxiety, palpitations, vaginal dryness, urinary problems, periods becoming heavier/more or less frequent. On average these symptoms last 4 yrs. While you are still getting periods you can still get pregnant. HRT is not a form of contraception.

• There are many things that can be done to help the menopause. A Healthy lifestyle can ease many of the symptoms. Sometimes the symptoms are so severe other things need to be tried. Herbal medication has been shown to help eg/ Red Clover,black cohosh but be aware that there is limited information on safety, drug interactions and over-the-counter products vary widely in doses they contain. HRT is without doubt the most tried and tested and effective treatment for many symptoms. There have now been many studies on HRT so we have much more evidence to go on. There is inconclusive evidence regarding HRT’s impact on dementia.

• HRT can be taken orally, as a patch, gel, even the contraceptive coil can be part of HRT. When taken around the menopause [below the age of 60 years] for less than 5 years there is a possible slight increased risk of suffering a stroke. Little or no increase in the risk of breast cancer. Little or no increase in the risk of heart attacks. In fact some studies have shown a reduction in the latter! There is a slight increase risk of blood clots ‘Deep Vein Thrombosis’ and a very slight increase in ovarian cancer. Some studies have shown the risk of DVTs and stroke is not increased if using a patch or gel. But most of the risks associated with HRT are more to do with the patient’s BACKGROUND RISKS already present. Hence the importance of LIFESTYLE. Obesity increases the risk of womb cancer greater than HRT.

• There is no arbitrary cut off for HRT use. After 5 yrs, women can continue for longer. It comes down to balancing the risks and benefits. This should be done at your HRT review.Stopping HRT can be stopped gradually or abruptly.

• HRT can be given intra-vaginally for vaginal dryness or urinary problems and does NOT have the same risks as above [but if you have had breast cancer your Specialists advice should be sought first].

• HRT can reduce the risk of osteoporotic fractures and is an option in the treatment of this around the menopause

• Bladder symptoms can be embarrassing and can effect women at any stage in their life but can be a particular issue around the menopause. Symptoms can range from urinary urgency, frequency, dribbling, loss of control. There are many things that can help these symptoms ranging from lifestyle advice, tablets, hormonal pessaries, to the more surgical such as injections and operations. There are less invasive surgical options nowadays.

• Some ladies experience something called a prolapse, which can involve the womb,vaginal walls,bladder or bowel. This can present as a feeling of fullness or a lump ‘down below’, sometimes associated with bladder or bowel symptoms. This is often linked to a drop in oestrogen at the menopause and more common if you have had vaginal deliveries or have had other gynaecology surgery eg/ hysterectomy. Again, there are lots of things that can be done to help. Yes, lifestyle advice! Plus pelvic floor exercises,tablets, hormonal vaginal pessaries to strengthen the walls, ,vaginal ring pessaries [to support the womb or vaginal walls if surgery is not an option/preferred], and surgery.

• One third of ladies over the age of 50 years suffer an osteoporosis-related fracture. Osteoporosis is thinning of the bones. Risk factors include family history, age, female,various medical conditions [eg/ coeliac,hyperthyroidism,rheumatoid arthritis,diabetes],medication [eg steroids,some anti-epileptics],smoking, alcohol [more thant 3.5 Units per days], low weight/BMI,premature menopause.

• It is difficult to detect but if you have lost more than 5 cm in height or have developed something called kyphosis [a bent forward posture] this could indicate osteoporosis and would warrant consideration of an x-ray of the back. Other low impact fractures eg/ wrist fracture from the standing position could also indicate osteoporosis. A special bone density scan called a DEXA scan can be used to confirm the diagnosis, but in some cases this is not required.

• Prevention of Osteoporosis is the key. Keeping a healthy weight, not smoking, minimal alcohol, WEIGHT-BEARING EXERCISES [eg/ walking], maintaining flexibility/stretching, balance classes to minimise falling, good calcium [see calcium calculator below] and vitamin D intake [800mg /dy and 400-800IU/day respectively]

• Treatment .......the bisphosphonates. They reduce the absorption of bone back into the body. The treatment course is at least 5 years and at this point consideration of a ‘drug holiday’ can be discussed with your doctor. They are most often taken as a tablet, and sometimes as an injection. There are other drugs, including HRT that may be alternatives.

• Useful websites:

  • Menopause [access to Forums,newsletters,menopause masterclasses] menopauseuk.org;menopauseacademy.co.uk/hcp;menopausematters.co.uk;thebms.org.uk
  • Bladder issues: bladdermatters.co.uk
  • Osteoporosis Society: Nos.org.uk.
  • Calcium calculator: cgem.ed.ac.uk/research/rheumatological/calcium-calculator
  • General lifestyle advice: midsussexwellbeing.org.uk
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