Antidepressants Blog

There is considerable confusion about hormone replacement therapy for a variety of reasons. In the past, very little good research was carried out on this topic, partly because no one has ever died from the menopause; and because most medical research is concerned with wider, life-saving issues. The situation is altering now because there is a more enlightened attitude to the effect of well-being on the woman, her family, and the community generally.

Confusion has also been created to some extent by the media. How can a reporter be expected to sort our medical detail? The media has often confused the issue just as the whole situation was becoming clear. The current confusion has made doctors afraid to give therapy, and women afraid to accept it. Some people are now being unnecessarily deprived of relief because of fear of the side-effects.

Some women need no help at this stage, others need it for a few months or a few years, or recurrently as the symptoms recur, and a few women need it for life. Some women who come into the clinic do not come back because they are urged to get off hormones either by their family or by their own consciences after reading press articles. Some people dismiss the whole business of menopause as a state of mind, and tell these women to pull up their socks and get on with it. In one survey carried out in our clinic, a high proportion of women who had complained of treatable symptoms had been told that they were menopausal, given a prescription for a tranquilliser and dismissed. On the other hand, there was a vogue in the 1960s in the United States for putting all women on oestrogens after the menopause, as it was regarded as a deficiency disease, much the same as diabetes. This vogue did not reach Australia to any extent.

We know it is not wise to give oestrogen to all women. For some, in whom oestrogens are contraindicated, it could even be dangerous. In addition they have side effects. Also, oestrogens do not reverse the ageing process, as some hope. They only alleviate symptoms which are oestrogen dependent.

*4\763\8*

This depends on the severity of your problem.

Simple measures Some women manage well with a lubricant cream such as KY jelly.

Local oestrogen creams and pessaries For those who do not want oestrogen tablets for general symptoms, and indeed a dry vagina may be their only symptom, local oestrogen creams or pessaries are the answer. Some patients feel these creams are unaesthetic and messy. If these are used, however, the absorption may be the same as if a similar dose is given by mouth and progestogens therefore should be given at regular intervals to shed the built-up lining of the uterus.

Oestrogen replacement therapy This cures vaginal dryness dramatically in 100 per cent of cases if this is due to oestrogen lack, and the result is obtained within weeks. The dose for this symptom alone is small and would certainly be your choice if other methods have failed. Vaginal dryness is a common symptom, and those doctors who deny that it is, I feel, do not enquire about it. It is important for doctors to be aware of people’s reticence in discussing such matters. This symptom has such a profound effect on marriage, and is so easily relieved.

The case history could be included here of a woman I saw twenty years after her ovaries had been surgically removed for endometriosis. With the removal of her ovaries her oestrogen production had stopped and she was suffering from lack of oestrogen. She was downcast and depressed, and she had not had intercourse for 14 years. On examination, her vagina was so constricted that I could introduce only a cotton bud to take a smear at routine examination. She complained that she was so dry and irritable in her vaginal area that she could hardly sit still. After a fortnight of oestrogen taken orally and applied locally I could readily introduce a bi-valve speculum. Her vaginal tissues had reverted to normal and she was happily having intercourse. The effects of the treatment are as rapid as that.

*14\63\8*

Hysterectomy

Hysterectomy means removal of your uterus only. This means you no longer have periods because your uterus and its lining have gone. It does not mean that your hormones have been removed as well. If your ovaries are left they still produce hormones which are still being released into the bloodstream.Therefore, after recovering from your operation, your sex life should not be affected at all.

Oophorectomy

Removal of your ovaries is oophorectomy, and menopausal symptoms result as the ovarian hormones are no longer being released into the bloodstream. Both hysterectomy and oophorectomy mean you can no longer have children.

Oophorectomy is an important decision and should be discussed with your doctor. Once your ovaries are removed the natural supply of oestrogen is stopped, except for small amounts produced outside the ovaries. You must weigh up the very small risk of developing diseased ovaries (and this is the risk taken by every other woman in the community), against the loss of one’s own hormones, the supply of which may continue, if only in a reduced way, until the upper age level if your ovaries remain. You and your doctor must sort this out before operation.

Only one ovary may be removed. This is sometimes done when one ovary is less diseased than the other, particularly in a younger woman. The remaining ovary will still produce eggs and hormones, and, if the woman’s uterus is present, she may still conceive.

You must know the facts It is important to know why you should have a hysterectomy and what it involves, so that you know precisely what will be done and feel satisfied that it is necessary. You and your doctor must sort this out before the operation. I am surprised at the number of women I see who do not know what they have had removed or why it was done. A large number of women, by the time they are sixty, have had hysterectomies. It is important to weigh up the need for any major surgery as there is a risk attached to such a major operation. For this reason, I feel having discussed it fully with your gynaecologist, if you have any doubts in your mind at all, you should have a second opinion from a quite unrelated gynaecologist.

Irradiation of ovaries

Irradiation of ovaries may occur when adjacent areas are irradiated; or it may be used as an alternative to surgery. Hormone production ceases when ovaries are irradiated, and menopausal symptoms may occur quite suddenly as the hormones are cut off, and in these instances the symptoms may be more severe.

*24\63\8*

Thrombosis No cases of thrombosis have occurred in our clinics. Thrombosis connected with oestrogens has been reported with the oral contraceptive pill, which contains synthetic ethinyloestradiol in doses higher than those generally used for menopausal symptoms. In our menopause clinics we use the so-called naturally occurring oestrogens Premarin, Progynova, Ogen and Oestriol. These hormones are reported to produce no increase in the incidence of thrombosis in the doses used.12 Also, I must underline, the dose used to control symptoms after the menopause is usually lower than the lowest dose of oestrogen in any contraceptive pill on the market.

Blood pressure Blood pressure does not usually go up with the doses used; in fact, as the patients settles, it generally goes down (about 10 mm of mercury). If the blood pressure does go up, as it does in a small percentage of cases, this is not an absolute contraindication to oestrogen therapy. The dose may be adjusted, the preparation may be altered or the blood pressure may be treated separately.

Sore breasts Some women get sore breasts, but these settle as the dose is adjusted.

*34\63\8*

Just as with any feature that is declining in function at this time, the skin needs greater attention. A good diet, plenty of fluids, and a decrease in cigarette and alcohol consumption all play a part. Moisturisers and night creams are also very useful.

Facial exercises My seventy-six-year-old aunt, who has hardly a wrinkle on her face, swears by facial exercises, and although I have no personal experience of them, exercise is so beneficial in general that I have no reason to doubt that they work.

Plastic surgery This is becoming more and more common and has a definite place for some. If removal of your wrinkles can improve your outlook, if your skin is past repair by simple methods, then this may help you dramatically. Enquire carefully, get good advice as to who achieves the best results, and ask all the necessary questions at your interview – for example you should know the expected results, time off work and in hospital, and costs involved. You may decided on a full facelift or a smaller treatment, for example on the eyelids or removal of puffiness from under the eyes.

Increase in pigmentation

Although increase in pigmentation with oestrogen occurs with the oral contraceptive pill, I have never observed this in dose levels used for oestrogen replacement therapy.

*44\63\8*

During winter, use a humidifier or vaporizer to raise the humidify inside your home. Low humidity dries out the mucosa lining nasal passages and increases risk of catching a cold or other upper respiratory tract infection. Being in an air conditioned room in summer also exposes one to low humidity with a similar effect on the nasal membranes.

Steeping with the mouth open also permits membrane linings to dry out and become more susceptible to viral invasion. Persons with a clogged Eustachian tube, or with sinus problems, are also more susceptible.

A person with the flu should stay home from work. If possible, that person should be restricted to one bathroom and should use only his or her own towel and washcloth. As far as possible, a cold or flu sufferer should be isolated in his or her own room and other family members should stay out. Only disposable tissues should be used.

It’s safest to avoid contact with anyone who has had a cold or flu for a week after the symptoms first appeared. However, a cold becomes contagious approximately twenty-four hours before symptoms appear.

Especially if you live in a small town or community, travel exposes you to new virus strains which can increase your risk of a cold or flu. If you live in a large city, where travelers are frequently importing new virus strains, risk of exposure to a new virus strain through travel is diminished.

Be careful about flying if you have a cold and are susceptible to ear infections. If you have a cold and fly, the plane’s descent may aggravate ear pressure. A sharp pain, or a discharge from the ear on landing, may indicate a middle ear infection or even a perforated eardrum. In either case, medical treatment is required.

Otherwise, ear infections can usually be prevented by blowing the nose gently and steadily. Sniffling is another common cause of ear infection, especially in children.

*223\30\4*

Recent research suggests that such time-honored remedies as a cup of lemon tea or a bowl of chicken or onion soup may be safer and more effective than many of today’s OTC cold medications. These hot beverages, it has been discovered, raise the throat temperature thereby inhibiting viral replication. Furthermore, acid drinks, such as lemon tea or tomato juice, create an acid environment in which the virus cannot exist.

Anyone with a cold or flu should try to drink eight to ten glasses of non-alcoholic liquid during the course of each day. Fluid replacement is especially important during fever when significant loss of body fluids can occur. Among the best drinks are warm, bland soups including onion soup and miso broth, both fruit and vegetable juices— including unsweetened orange, grapefruit, apple or grape juice and also carrot and tomato juice—and carob drinks and teas. Although they contain caffeine, an occasional cup of black or green tea can contribute to the patient’s feeling of wellbeing. Try to drink at least half a glass of water or other liquid every half hour.

*199\30\4*

Preliminary studies have suggested that moderate amounts of vitamin E (in the range of 200 1U per day) assist phagocytes in destroying pathogenic invaders In contrast, a deficiency of vitamin E has been found to diminish antibody production and to inhibit lymphocyte proliferation in response to a non-self antigen.

Vitamin E is an antioxidant, meaning it has a powerful capacity to neutralize free radicals (stray electrons which can reactively damage the genetic nucleus of body cells). Several studies have shown that in enhancing immunocompetence, vitamin E works synergistically with other antioxidants such as vitamin C and the mineral selenium.

It has also been observed that megadoses of vitamin E have had the opposite effect. They have inhibited immunocompetence and in some cases, they have increased Wood pressure. For this reason, many nutritionists suggest a daily maintenance dose of 100 IU of vitamin E during the cold season. During a cold, this can be increased to 200 IU, returning to the 100 IU dosage some two weeks later. It has also been suggested that during a cold, older people could take up to 400 IU per day because of poorer absorption potential. This amount should not be maintained for more than 14 days.

It is important to be certain that you are taking vitamin E only in the form of d-alpha or d-alpha tocopherol. Other varieties such as beta, delta or gamma tocopherol offer fewer benefits. For best absorption, the acetate form of alpha tocopherol is often preferred.

*171\30\4*

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.

This is inflammation of the pharynx, that portion of the throat above the larynx. Pharyngitis can be caused by either a virus or bacteria. Strep throat, a bacterial infection, is the most common and dangerous form of pharyngitis. Invariably, strep throat is accompanied by a high fever and an excruciatingly painful sore throat. Difficulty may be experienced in breathing, swallowing and speaking and the throat is red and raw. Although strep throat is not particularly common, it can lead to kidney disease, rheumatic heart disease or rheumatic fever. It can be positively diagnosed only by a two-day throat culture taken by a physician. Strep throat responds fairly readily to antibiotics.

Fortunately, most sore throats are not due to strep throat. Simply sore throat can be treated at home by resting the throat with a liquid diet, using slippery elm lozenges and gargling with salt water to relieve throat distress.

*147\30\4*

When pitted against cold or flu viruses, the immune system eventually always wins. But the speed with which a person’s immune system can wipe out a cold or flu is largely governed by his or her immunocompetence. In viral infections, immunocompetence focuses on the speed at which specialized white cells can manufacture antibodies and other virus-fighting immune system components.

In a person with low immunocompetence, a cold may linger on for ten to fourteen days before the immune system can finally muster sufficient antibodies to destroy it.

In a person with average immunocompetence, a cold typically lasts about seven days. A person with moderately high immunocompetence may be rid of a cold in only four days.

But a person with optimal, peak immunocompetence can often recover from a cold completely within twenty-four hours.

New research is showing that many of the therapies which have been suggested in the past, such as taking vitamin C or zinc gluconate lozenges, are effective boosters of immunocompetence.

*123\30\4*