Healthpharmablog. About Health & Medicine

- What causes night sweats, and how are they linked with hot flushes?

Night sweats are probably hot flushes with the bedclothes on. Flushing and sweating attacks tend to go hand in hand and peak in the years after menopause. The sweating sensation usually takes longer to subside than flushes do.

- Will my hot flushes return with a vengeance if I stop HRT too soon?

HRT does not seem to affect the duration of hot flushes. If you stop HRT, and you are still in the flushing phase after menopause, your flushes will return. Every woman on HRT for control of hot flushes reaches a point where she wonders if it’s time to take a break and see how her body responds. Going off HRT may indicate that the phase of flushes is over or, if not, it will remind you of why you started on HRT in the first place. After a while, of course, the flushes will subside normally — just as they would if you had no HRT.

- I’m told many women give up HRT after a year or two. Why would they do that?

For a variety of reasons, such as bleeding, a dislike of being on medication for an extended time, and concerns about the long-term possibility of increased risks of breast and endometrial cancers.

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BLADDER DISEASE Hormone replacement therapy undertaken by such women may change the composition of bile and increase the incidence of gallstones. If you have gallstones and want HRT, be cautious about it and give preference to the patch format. Hormone therapy is suitable for women who have had their gall bladders removed, provided there are no other reasons against it.

WOMEN WITH DIABETES Hormone replacement therapy may be prescribed for women with diabetes. However, if you have diabetes you should realise that your blood sugar levels are likely to be disrupted during the first few months of hormone use. This may necessitate changes in the dosage and timing of your medications, particularly if you use insulin. Patches or implants are the preferred form of HRT for women with diabetes. Although some research has been conducted on the impact of oestrogen on blood glucose levels, there is relatively little information on the effects produced by hormone combinations such as oestrogen and progestogen.

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The HRT dosage prescribed depends on a number of factors such as its purpose (for example, mainly for symptom control or mainly for reducing the risk of later heart or fracture problems) and a woman’s individual response to it. The oestrogen dosages needed to relieve symptoms may be higher or lower than those required to provide long-term protection against heart disease and osteoporosis, depending on the severity of symptoms. Women on HRT before menopause is confirmed cannot rely on it for contraception as hormone dosages are insufficient to prevent pregnancy. As explained previously, a low-dose combined Pill is one way of obtaining both the benefits of HRT and contraceptive protection.

Whether it is taken every day or for ten to fourteen days per cycle, the total monthly dose of progestogen in HRT is similar to that given to a woman on the Pill. The dosage used by Tessa, who is taking progestogen daily, was arrived at by lowering the daily dose until she had breakthrough bleeding, then adjusting upwards.

Individual variability in the body’s capacity to deal with the hormones of HRT is another reason why a dose that relieves symptoms in one woman has little effect on another. In the case of hormone patches and implants, the position on or in the body affects the amount of hormone the body absorbs and therefore the dosage required.

When a doctor is deciding on the most suitable dosage or hormone format for you, your individual response will be crucial. The hormones used initially may not relieve your symptoms adequately, or they may have unwanted effects. It may then be necessary to change the kind of oestrogen or progestogen used, or to alter the dose.

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An artificial menopause can also be caused by chemotherapy, the drug treatment used against many types of cancer. Chemotherapy directed at any part of the body prior to menopause may result in a chemical menopause, but regrettably many women are not warned about this possibility. Marcia was upset to learn while having chemotherapy for leukaemia that her ovaries would no longer function after the treatment. ‘It was the last thing on my mind at the time I started chemotherapy, and the hot flushes I experienced some weeks later came as a most unpleasant surprise,’ she recalled. ‘Fortunately I have three children and wasn’t intending to have any more. However, I would have appreciated being told earlier about this effect of chemotherapy.’ Menopause may also be caused by radiotherapy to the ovaries, when x-ray treatment is given for a cancer in the pelvis.

Early natural menopause in the absence of any medical intervention is more likely in women who smoke (smokers experience menopause one to two years earlier, on average, than non-smokers and ex-smokers, the reason being that smoking reduces the availability of oestrogen to body tissues). Later menopause is more likely in woman with many children, and women who are heavier than average. Genetic and nutritional factors also seem to play a part: the menopause for Asian women apparently occurs earlier than for those with northern European backgrounds.

Sometimes none of these reasons accounts for spontaneous premature menopause, which on rare occasions can be found in women in their thirties or, even more rarely, in their teens or twenties. Studies suggest that the egg supply of most of these women has run out, but it is not clear whether this is due to a shortage of eggs at birth or, as is more likely, some unknown factor.

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These are very similar to stomach ulcers, but occur in the first part of the small intestine – the duodenum. The main symptom is pain, several hours after eating. This pain is usually felt in the upper abdomen, although sometimes it appears to be in the back.

Most duodenal ulcers result from excessive acid production in the stomach. All the causative factors described above for stomach ulcers are also operative in duodenal ulcers, particularly anxiety, tension, smoking and drinking too much alcohol. Wine and spirits are the main offenders. Duodenal ulcers also seem to be linked with eating a lot of pickled food, and eating refined carbohydrates that is, sugar and white flour. Duodenal ulcers tend to heal themselves, provided the original causes are removed.

Again, a small minority of patients with duodenal ulcers may be suffering from food allergy or food intolerance – but there is little hard evidence to support this belief, only individual case-histories.

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Try this way of life as an experiment either during your holidays or when you are convalescing from an illness. Instead of going out in the evenings on some social occasion that may last far into the night, take the opportunity to enjoy some natural sleep several hours before midnight. If, during our holidays, we accustom ourselves to this way of life, perhaps when we return home we may succeed in cancelling our social obligations on two or three weekday nights in order to enjoy the regenerative power of natural sleep. Our business and social life will actually benefit, for our energies and strength will be renewed. If, on the other hand, we behave like most people on holiday and stay up all hours of the night indulging in social life to the full, then we should not be surprised if our body and mind are still tired once it is over.

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I am always reminded of visiting a hospitable desert Bedouin in his tent whenever someone complains about a hot summer’s day in my native Switzerland, where cold and rainfall are well known but not real drought. In the shade of his black goat’s-hair tent the temperature must have been around 40 °C (104 °F) and the air outside was shimmering in the heat. In spite of this the bearded man, whose deeply lined face betrayed his advanced age, served me hot tea. I was astonished and wanted to know the reason. His answer was quick. It was completely wrong, he said, to drink cold water in the intense heat; it would only increase the thirst instead of quenching it. And so would sweet drinks, he added. It would be asking for trouble and not healthy either. At the time of our conversation I was still doubtful about his conclusion, but eventually it was confirmed by my own personal experience. It is really true that a hot drink or juicy fruit are better than anything else to quench one’s thirst in the heat. What is more, they may prevent you from catching a cold, but there is no guarantee for that if you gulp down ice-cold beverages.

It is also important to breathe through the nose when it is very hot, not only when you are in the cold. The nose is equipped with a built-in air-conditioning system, or temperature control, which warms up the incoming air in the winter and cools it down in the summer.

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The subject of dairy farming leads me to comment on a strange policy among some dairy farmers. There are some farmers who muzzle calves to prevent them from eating hay or aftermath. By feeding them only on milk their flesh will remain white, the idea being, of course, that white meat fetches a better price. This view of things, aided and abetted by the consumer, is extremely shortsighted, because red meat is of better nutritional value. However since the white meat is more tender, it is also more expensive.

The same principle applies to white bread, white rolls and other white flour products, showing once more the power of advertising and how demands are created to spoil the palate so that artificially prepared foods with all their additives seem to taste better. The knowledge that they are greatly inferior to products made from whole cereals is simply ignored. If one continues to eat white bread, lack of fibre will soon weaken the peristalsis of the intestines and lead to constipation, which, in turn, encourages a host of other troubles that will ultimately be dealt with by injections and all sorts of harmful drugs and medicines. One mistake after another is made and, sooner or later, the price for choosing one’s food according to the dictates of the palate will have to be paid for by chronic ill health and physical suffering.

How much wiser it would be to adapt oneself to the more healthy foods, which give a true sensation of taste, instead of the cultivated taste for the artificial. It is not only the individual who would be the ultimate beneficiary from eating natural health foods, but the economy of the land would be boosted as well.

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As more instances of poisoning from eating fruit sprayed with pesticides come to our attention, we would do well to consider the different aspects of this dangerous practice.

Some people do not react immediately to poisons such as lead, arsenic and copper sulphate used in sprays, being less sensitive. Others are more sensitive and immediately show signs of poisoning upon eating sprayed fruit. Be it as it may, when buying fruit one should make sure it has not been sprayed. It is common to find blemishes or an occasional brown spot on fruit that has not been treated with insecticides, but the fruit is still edible and its goodness is not impaired, since these blemishes are harmless plant fungi.

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In planning a healthy diet, the following suggestions should provide some useful guidance.

For breakfast to be nourishing and wholesome, the ideal foundation is muesli with apples or other seasonal fruit. Add nuts and wholegrain flakes to enrich it further. A highly nutritive addition is whole wheat, first soaked and then put through the mincer. Raisins or sultanas can be mixed with the wheat before it is minced; these are excellent for the blood. A level tablespoon of ground linseed may also be added if constipation is a problem. Use honey or grape sugar to sweeten.

Crispbread, wholewheat or whole grain bread (for example Vogel’s Whole Grain Flake Bread) with a little butter, honey or rose hip conserve can follow the muesli. If you like, sprinkle some wheat germ on the bread or over the muesli.

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