THE MENOPAUSE: HOT FLUSHES AND NIGHT SWEATS (PART 1)
Hot flushes and night sweats belong in a category of symptoms that doctors call ‘vasomotor symptoms’, that is they are concerned with the blood vessels dilating and constricting, and with the flow of blood through these vessels. The symptoms are harmless, but most women greatly dislike having them, and find them uncomfortable, embarrassing and unpleasant. They may also affect a woman’s ability to cope at work and at home, and she may even avoid social contact for fear of feeling ashamed.
The typical hot flush starts as an unpleasant sensation of heat in the face, neck or body. If it starts in the face or neck, it will probably spread down to the main part of the body; if it starts there it will spread up to the face. Often the face becomes red, and sweat appears; but many women find, to their surprise, that, despite the feelings of great heat in their face, there are no outward signs at all, and nobody has noticed.
Flushes may occur at intervals from several each hour, to just a few times each month, usually in the days leading up to the start of a period. There will be times when flushes occur frequently, and times when they do not occur at all. Each flush may last for a few seconds, or for up to half an hour, or more, but most last for about three minutes. After a flush, you may feel sweaty, then cold, and you may seem to be endlessly taking clothes off and putting them on again to get comfortable. Flushes can occur at any time of the day or night, and may be accompanied by heart palpitations, dizziness and feelings of faintness. In America, they are called ‘hot flashes’, but this is a less appropriate name, as it suggests something that comes and goes very rapidly. The British term ‘hot flush’ describes more accurately the feeling of heat that builds up and dies down slowly.
When flushes occur at night, they are called ‘night sweats’. Typically, a woman will wake from sleep to find she is drenched in sweat and has to get up to change her night-clothes, and perhaps even the bedding. Night sweats cause greatly disturbed nights and lack of sleep, for the woman suffering them and perhaps also for her partner who may find himself woken several times in the night as she gets up to wash and change into something dry. Repeated broken nights cause fatigue, loss of concentration, irritability, and a general sense of lethargy.
The underlying cause of a hot flush is a falling level of oestrogen. This is not the same as a low level: girls before puberty and men have low levels of oestrogen, but they don’t suffer hot flushes; women get them when the level of oestrogen in their body has been high and then starts to fall. Women who lose their oestrogen suddenly, as when they have both ovaries removed, tend to get flushes that are particularly troublesome. If the decrease in oestrogen is gradual, the symptoms will be less severe. In most cases, once the body has adjusted to its final low level, the flushes will end.
It is thought that the falling level of oestrogen throws the body’s heat-controlling mechanism into confusion, and the ‘thermostat’ becomes set too low. The result is that the body thinks it is suddenly too hot, so it dilates the blood vessels and sweats to cool itself down. The dilated blood vessels produce redness and a sensation of heat in the skin, but although the skin itself may become several degrees warmer than normal, the body’s underlying temperature remains unchanged. Even if the skin hardly becomes warm at all, the woman will still feel hot – usually uncomfortably and embarrassingly so.
Flushes can be triggered by several things – or by nothing. Common causes of a flush are: anxiety, hot weather, moving from a cold room to a hot one, drinking tea, coffee, alcohol or hot drinks, or eating spicy food. However, most flushes don’t seem to be triggered by anything. As smoking reduces oestrogen, smokers tend to find flushes more troublesome than non-smokers do.
If you get hot flushes, you may feel freakish, and wonder if everyone is staring at you. In reality, the chances are that no one will notice, and, far from being a freak, 75 per cent of women going through the menopause get hot flushes, just like you. Of that number, 80 per cent still have them a year after they first appeared, 25 per cent still have them five years later, and for an unfortunate 5 per cent, they continue indefinitely.
*10\42\4*
HYSTERECTOMY: ‘WATCHFUL WAITING’
For some women, coping with difficult menstrual bleeding or painful periods without drugs or surgery is an option worthy of serious consideration. The rationale for a ‘watchful waiting’ approach hinges on the well-established finding that oestrogen plays a major role in the growth of fibroids and endometriosis. When oestrogen output by the ovaries decreases after menopause, these conditions tend to become much less worrying. Many women are therefore prepared to give the watchful waiting approach a try if their period problems are bearable and they are nearing menopause.
Julia experienced intermittent, heavy and painful bleeding due to fibroids for two-and-a- half years before her menopause and considered having either a myomectomy or a hysterectomy during this difficult time. Looking back some years later Julia was pleased that neither procedure was ultimately necessary.
There are many reasons for difficult-to-manage bleeding patterns apart from fibroids. Lauren had lengthy menstrual bleeds in her late forties that were different from anything she had experienced previously. During them, spotting was typical on the first few days, then there were several days of heavy bleeding which resembled the heaviest bleed of former periods, followed by a handful of days when the bleeding tapered off. Managing the blood loss was tiresome because it went on for so long and Lauren was also concerned about the possibility that something was seriously amiss. Medical investigations including a hysteroscopy did not reveal any suspicious lumps or growths and showed that she was not anaemic. Doctors said changes in her sex hormone levels, consistent with an Impending menopause, were to blame for her symptoms. In order to sort out whether Lauren’s blood loss was excessive, it was suggested she record what her bleeding was like. ‘Keep a diary of how many days it lasts, how many and what sort of sanitary pad or tampon you use, whether pain occurs and when,’ her doctor said. ‘Then we’ll discuss the findings.’
Lauren’s diary confirmed that her blood loss was heavy and prolonged and a number of possible medical therapies were discussed as well as the option of watching and waiting. After talking with friends who had negotiated similarly difficult bleeding, Lauren decided to try a non-medical approach for a few more months. In particular, she started experimenting with dietary changes, including some herbal products, and the use of highly absorbent ‘overnight’ sanitary pads when the bleeding was heaviest. Her boss, who had herself been through similar difficulties some years earlier, was supportive and understanding. Lauren bled profusely at night on several occasions and found it reassuring to have a mattress protector in place as well as a towel beside her bed in case of flooding. After several months her periods dwindled then stopped.
An increasingly common cause of bleeding in the post-menopausal age group is hormone therapy. Sometimes there is no apparent reason why such problems affect one woman and not another. Occasionally the explanation seems to be pre-existing fibroids or the use of an oestrogen implant as part of post-menopausal hormone therapy. It has been noted that implants cause severe uncontrollable bleeding in some women, presumably because they deliver larger amounts of oestrogen than other hormone therapy formulations, for some of the time at least.
Another possible cause of bleeding is cancer of the endometrium in post-menopausal women who have used oestrogen therapy (in pill, patch or implant form) without added progestogen for several years. Even after oestrogen is no longer taken, the risk of cancer of the endometrium persists. It is important to seek medical advice promptly if this possibility applies to you.
The decision about whether to watch and wait or to try medical treatments or surgery depends on many factors including the amount of bleeding and its effect on daily living, the ability to cope with such difficulties, general health, the rate of change in conditions like fibroids, and the probable time to menopause. Situations in which watchful waiting is generally considered to be inappropriate include rapid fibroid growth resulting in a significant and measurable increase in the size of the uterus during a six-month period, bowel or urinary obstruction, and symptoms which make life seem hardly worth living.
*25\198\4*
DREAMS—PSYCHOLOGICAL FILTER
We are now going to explore the use of dreams from another angle. But first let us recapture some of the facts about dreams and REM sleep. When a person is sleeping in the sleep laboratory, if he is awoken immediately after the REM sleep he will nearly always be able to recall his dreams vividly. But if he is awoken five minutes after the cessation of REM sleep, he will have only a vague recollection of the dream. If he is awoken ten minutes after the REM sleep, he will have difficulty in remembering any dream. It is quite normal to forget our dreams, and some people can never remember their dreams and believe that they never dream at all. Most of us wake from our dreams in the morning and still have our dreams fresh in the mind. However, when activities of the real world set in, the dream details disappear. As the day continues, you normally cease to think of your dreams—your mind is occupied with real tasks and real problems. Hence forgetting our dreams is normal and healthy.
Once, on waking in the morning, my wife Patricia tried to tell me about an interesting dream. However, by the time we were having breakfast and discussing the day’s work ahead of us, she had totally forgotten the contents of the dream. Patricia manages my clinic and is also a registered nursing sister. Unless we make a conscious effort to remember a dream, such as writing it down, it vanishes from memory. Just stop for a moment and think. Can you remember the dream you had the night before?
While we are dreaming we act out and experience some of our unconscious wishes and desires. Some of these desires may be very wicked and sometimes even immoral, and some of these desires may be too ambitious or even against the law and can never be fulfilled in real life. The dreams seem to satisfy our wishes and desires and let us experience them as if they are real and as if our dreams have come true.
Once these desires are satisfied, they are meant to be forgotten, so that the mind will no longer be disturbed by these desires and we can get on with our normal daily lives. In this theory about dreams, we are not encouraged to remember dreams or to analyze them. Dreams are perhaps a psychological filter and are used to dispose of our accumulated unconscious desires that may disturb our normal daily activities. After all, nature has designed dreams in such a way that most dreams are forgotten the next morning. Dreams are used to balance out our inner psychic life.
*25\174\4*
THE MENTAL EXERCISES ARE EFFECTIVE IRRESPECTIVE OF THE CAUSE OF ANXIETY
It is clear that this approach is not directly related to the actual cause of the tension. This is an important point. At present there is a popular vogue that the only really satisfactory way to treat nervous illness is to unearth the cause. A little thought shows us that this is simply not true. Many people recover from nervous illness when they are given appropriate drugs, and we must not forget that religious experience, meditation, and philosophical practices have brought peace of mind to many who were disturbed. Furthermore, every psychiatrist knows that many patients can be brought to a full knowledge of the previously unconscious conflicts which caused their condition, but their symptoms will remain. Our own brief review of the causes of anxiety has shown that tension often results from a multitude of minor personal stresses of which the patient may be quite aware.
Our present approach to the relief of anxiety and tension by relaxing mental exercises works by aiding the natural processes of the body. It is effective irrespective of the cause of the anxiety; and above all else it is essentially a natural process.
*50\57\2*
WHAT IS MIXED ARTHRITIS?
There are numerous other types of arthritis which could be classified under the common heading mixed arthritis. Arthritis deformans is a term often used to describe a certain type of arthritis. Actually, though, arthritis deformans is more a description of a condition of severe deformation from osteoarthritis, rheumatoid arthritis, and many other causes than a specific type of disease.
Ankylosing spondylitis is a vicious form of arthritis which mainly strikes down young males under the age of 20. It seldom occurs after age 30. Sacroiliac joints are the most frequent locations of spondylitis.
The types of arthritis which are most topical for the purpose of this book, however, are rheumatoid arthritis and osteoarthritis. Together they are responsible for over 90 per cent of all the cases of arthritis in this country. Rheumatoid arthritis is the most painful and crippling type of them all, and it affects people of all ages, particularly those who are in their most active and productive period of fife.
*7\176\2*
THE FACTS-THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY: OTHER CAUSES OF IMPAIRED OXYGEN SUPPLY TO THE BRAIN-DROP ATTACKS AND JUMPING LEGS (MYOCLONIC JERKS; HYPNIC JERKS)
These affect only middle-aged women, and then often only for a year or two. The story is striking. The woman complains that, while walking along, she suddenly finds that her legs have given way. She may land on her knees or pitch forward on her face. In either case she is always adamant that she is fully aware of what is happening, and equally adamant that she does not trip. The condition is variously assumed to be due to some weakness of the thigh muscles, or to a disturbance of blood flow in the brain-stem, interfering with postural reflexes. Whatever the mechanism, neurologists are confident that there is no association with epilepsy.
Jumping legs (myoclonic jerks; hypnic jerks)-About 80 per cent of the adult population, at some time in their lives, are conscious of a sudden jerk of one or other leg, usually in the twilight stage of drifting off to sleep. The jerk is associated with, or may cause, a sudden arousal. Some people have a great number of jerks, so many that their spouse, being bruised by the kicks, will refuse to share a bed with them. These jerks must represent some sort of paroxysmal discharge of nerve cells, not necessarily in the brain. They are therefore in this way close to epilepsy, but are not so regarded because of their near universality in the population, and their lack of association with frank epileptic seizures. Specifically, there is no relationship between these jerks and the morning myoclonic jerks associated with typical absence or tonic-clonic seizures.
*41\188\2*
MILD TO MODERATELY SEVERE RHEUMATOID ARTHRITIS
In Group #3, fourteen subjects presenting with mild to moderately severe rheumatoid arthritis were supplied with 24 capsules, two capsules to be taken each morning and evening for six days. After three days of treatment eleven reported about 20% to 30% improvement in articulation and inflammation, and about 40% to 50% relief of arthritic pain. In these eleven subjects improvement continued rapidly over the next four days, approaching the 80% to 100% level. The remaining three subjects reported similar improvements by the end of the fourth day, with an overall improvement of 70% to 80% after seven days.
Most of the subjects continued to report minor additional improvement for one week or more even though they were no longer under treatment. However, six in this group began to experience the return of some mild arthritic symptoms after about three to four weeks. (Although not included as part of this study, all of the subjects in this group were treated again and their level of improvement has subsequently stabilized.
*62\142\2*
MENINGITIS IN CHILDREN
Symptoms: fever, stiff neck, headache, vomiting, exhaustion or collapse, convulsions.
Home care:
Meningitis is a medical emergency. Do not attempt home care. Take the child to the doctor immediately.
Precautions
- A child, who is very weak, has a stiff neck, and fever should see a doctor immediately.
- Laboratory examination of spinal fluid is the only way to diagnose meningitis.
- Meningitis can follow an upper respiratory tract or middle ear infection, or certain types of skull fracture.
- Meningitis is often contracted through direct contact with a carrier of the disease who appears quite healthy.
Meningitis is an infection of the meninges, the layers of tissue that cover and protect the brain and spinal cord. Most often, meningitis is caused by a viral infection. Bacterial meningitis is usually caused by one of three types of bacteria: meningococcus, pneumococcus, or Haemophilus influenzae. Meningitis is seldom spread by a person who has the disease. It’s usually contracted by direct contact with a healthy person who is a carrier of the disease, or by inhaling airborne droplets of moisture from that person’s respiratory system. (A carrier is a person who does not get sick with the disease but can pass it on to others.)
Meningitis may be a complication of a skull fracture if the fracture has extended into the nose, middle ear, or nasal sinus. Meningitis can also follow an upper respiratory tract infection or middle ear infection.
Signs and symptoms
The characteristic symptoms of meningitis are moderate to high fever, headache, vomiting, exhaustion or collapse, convulsions, and a stiff neck – the child cannot touch his or her chin to the chest with the mouth closed. Purplish red spots (petechiae) scattered over the body together with fever may indicate one form of meningococcus infection. The diagnosis of meningitis can only be made with certainty by testing spinal fluid obtained by a spinal tap.
Home care
Meningitis is a medical emergency in which hours, if not minutes, count. Do not attempt any home treatment. See a doctor at once.
*148/84/5*
REDUCING CHOLESTEROL: HERBS TO HELP YOUR HEART
Tea
Tea is the most widely consumed beverage after water, and archeological evidence suggests it was consumed 500 000 years ago, originally in China and India. Tea refers to the plant Camelia sinensis, and there are three main varieties: black, green and oolong. The difference between these is the way they are processed. Green tea is made from unfermented leaves, and contains the greatest amount of antioxidants. The leaves of black tea have been fully fermented, and oolong tea leaves are fermented for a shorter period of time.
Green tea is very high in a type of antioxidant called catechins. The main catechins found in green tea are epicatechin (EC), epigallocatechin (EGC), epicatechin gallate (ECG), and epigallocatechin gallate (EGCG). The last one is considered the most powerful, and research has proven it to have strong disease fighting properties. Tea drinkers appear to have a lower death rate after a heart attack than non tea drinkers. Green tea was found to prevent the development of atherosclerosis in mice. This could be due to the antioxidants in it preventing the oxidation of cholesterol, and damage to the artery walls, and/or because tea has a dilating effect on the arteries.
A study published in the Journal of Agriculture and Food Chemistry analyzed the antioxidant activity of 22 vegetables as well as green and black tea. The researchers found that both green and black tea had much higher antioxidant activity against free radicals than all of the vegetables studied. Of the vegetables studied, garlic was the most powerful antioxidant, followed by kale, spinach, Brussels sprouts and broccoli.
Eat your herbs and spices
Garlic has been used as a food and medicine in many cultures for thousands of years. First of all garlic is a strong antibiotic, it is able to kill a variety of bacteria, viruses, fungi and intestinal parasites. This is useful, as several infections have been associated with a higher risk of heart disease. If you eat garlic regularly, you are not likely to have hidden chronic infections in your body. Garlic is also a strong antioxidant, helping to protect our cells and tissues from damage and inflammation.
Studies have shown that garlic can help to prevent blood clots; it thins the blood, helps to lower cholesterol and blood pressure. It may even act to lower blood homocysteine levels. Include garlic in your meals regularly; it is best eaten raw, as cooking destroys some of the active components in it. Onion, leeks and spring onion all have similar properties to garlic; they are just not as strong.
Ginger has been used in India, Asia and Arabic countries as a medicine since ancient times. Modern research has shown that it helps to protect us against heart disease in a number of ways. Ginger helps to reduce inflammation in the body; you may be aware of its positive effects on arthritis and menstrual pain; these conditions are both stimulated by inflammation. By reducing inflammation, ginger is also able to inhibit the process of atherosclerosis in our arteries. Ginger is able to lower blood cholesterol and triglyceride levels, and because it is an antioxidant, it has the ability to prevent the oxidation of LDL “bad” cholesterol.
Turmeric is becoming known as a wonder spice with the ability to prevent many diseases. It is a close relative of ginger, has an intensely yellow colour and is the main ingredient in curry powder. The main benefits of turmeric are its strong antioxidant and anti-inflammatory actions. It is able to lower cholesterol levels and prevent the oxidation of LDL “bad” cholesterol. Turmeric also inhibits the accumulation of platelets in artery walls that have been damaged. This is good because it inhibits the formation of blood clots that can block arteries and lead to heart attacks and strokes. Research has also shown turmeric to exhibit anti cancer effects, and inhibit the development of dementia. You can find powdered turmeric in the supermarket, which you can use in cooking. The fresh rhizome is often available in Asian grocery stores.
*52/53/5*
EFFECTS OF NUTRITIONAL SUPPLEMENTS ON FERTILITY: FOLIC ACID
There is now a great deal of scientific knowledge about the use of nutritional supplements and their beneficial effects on both male and female fertility. These supplements can be very effective in rebalancing your hormones, as well as improving your and your partner’s overall health – so vital for successful conception.
Folic acid deficiency is the most common vitamin deficiency in the world, partly because the body cannot store large amounts of folic acid. It really only has sufficient for one to two months so it is essential to supplement.
Of course, we now know that folic acid can prevent spina bifida and it is essential that it is in good supply before and during pregnancy. But that is not all.
Folic acid is just one of a number of  vitamins. To successfully produce the genetic materials DNA and RNA, you must have enough folic acid, together with vitamin B12. This co-dependency is common between nutrients and, because of such interactions, it is naive to think that supplementing with folic acid alone before pregnancy, as suggested by the medical profession, is enough.
You have to remember that doctors are not generally trained in nutrition. (They receive only a few lectures on the subject while they are studying if they are lucky.) By giving advice in isolation and without the necessary nutritional training, other complications can arise. For example, since folic acid and vitamin B12 are inextricably linked, it is possible to mask a B12 deficiency (pernicious anaemia), for instance, by giving folic acid alone.
A US study found that women taking a multivitamin before conception had fewer babies with a cleft lip. The immediate assumption was that it was probably the folic acid that was making the difference. But, since all the other vitamins were also being taken, it could have been any one of them that had the positive benefit. More likely, it was the combination of all the nutrients.
Recent research into heart disease suggests that folic acid and vitamin Â12 might be beneficial in controlling an amino acid called homocysteine, found in the blood, that causes damage to the lining of blood vessels. Since high levels of homocysteine are also found in women who have miscarriages, it surely follows that folic acid and vitamin B12 might be helpful to these women too.
When trying to get pregnant, you should also be aware that folic acid deficiency is common in people with chronic diarrhea or malabsorptive states such as coeliac disease and Crohn’s disease. Alcohol causes the body to excrete folic acid, and certain drugs-, such as those for epilepsy and oral contraceptives, can cause a folic acid deficiency. So, if you fall into any of the above categories, make sure you supplement with folic acid before trying to get pregnant.
You should take 400mcg a day. (You also need to take vitamin B12).
*45/73/5*
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