Health News and Information

- One of my neighbours has had what she calls a total hysterectomy. Does that mean her ovaries as well as her womb have been removed?

The medical definition of a total hysterectomy is the removal of the uterus and cervix, so your neighbour should still have her ovaries intact. This is the usual type of hysterectomy performed in Australia. If the ovaries are removed along with the uterus and cervix, the procedure is called a hysterectomy plus a bilateral salpingo-oophorectomy.

- Why am I still having heavy monthly bleeds after ten years on HRT?

A large uterus, and therefore a large surface area of endometrium, is sometimes responsible for heavy bleeds. Another possibility is that fibroids protruding through the endometrium are being stimulated by the hormone therapy to grow and bleed. If you discuss this problem with your doctor, it is likely that he or she will suggest a hysteroscopy to check the endometrium. If there is no apparent problem, you may find that your bleeds become lighter with continuous combined HRT (that is, a small dose of oestrogen and progestogen daily).

– I had a couple of clots in my leg fifteen years ago. Should I avoid HRT?

This depends on whether the clots occurred spontaneously or followed surgery, childbirth or some type of traumatic accident. In either case a thorough assessment of your blood clotting system is called for at the outset.

If the clots appeared ‘out of the blue’, there is reason for caution with HRT because of the possibility that it may aggravate your clotting disorder and lead to a blocked blood vessel and, at worst, a stroke or heart attack. You may be willing to accept this risk if your menopausal symptoms are particularly severe. If so, the safest HRT option for you is a patch.

If, on the other hand, your clots followed surgery, birth or trauma, it is reasonable to try HRT in patch form after an assessment of your clotting system.

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Unexpected bleeding, known as breakthrough bleeding, can occur at any time of the month if you are taking both oestrogen and progestogen throughout your cycle. If you are on progestogen for only part of the cycle it can occur at times other than the end of the progestogen phase, and in such cases a thorough assessment by hysteroscopy is essential. If there is no problem with the endometrium, the dose of hormones is probably inadequate. The bleeding is usually stopped by alterations to the dose or potency of the oestrogen or progestogen.

If you do not want to have to cope with any bleeding, a change to the combined oestrogen and progestogen regimen may reduce breakthrough bleeding, or else you may consider having your endometrium removed. Paradoxically, although fewer women experience withdrawal bleeds with the combined format, about 10 per cent are still experiencing breakthrough bleeding a year later. The problem of breakthrough bleeding appears to be worse in women who are close to menopause or who have a recent history of disturbed bleeding, and it is for this reason that they are more likely to be given progestogen for part of the cycle rather than throughout it. Older women who are commencing HRT after several years without a bleed seem to have fewer problems with breakthrough bleeding.

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Approximately 40 per cent of women in the Melbourne Women’s Midlife Health Study who had a natural menopause between the ages of forty-five and fifty-five experienced hot flushes and night sweats around this time. This figure, lower than reported in many other studies, reinforces the need to study non-clinic populations of women as well as those with a greater burden of symptoms, many of whom have had a premature menopause with or without medical intervention.

In the early menopause group, the incidence of hot flushes may reach 70 per cent or more. Insomnia, which affected about 40 per cent of menopausal women in the Melbourne study, is sometimes due to a woman waking repeatedly in the night, drenched from heavy sweating. The distressing combination of night sweats and insomnia may interfere with sexual interest and activity as well as making it more difficult to cope with the following day and its pressures.

Pauline was prescribed tranquillisers by the first doctor she consulted about her problems of night sweats and insomnia. ‘I told the doctor how I’d wake in the early hours of the morning in a lather, I’d toss and turn and still not get back to sleep. In the process I’d disturb my husband, who’d get cranky because he had a lot on his plate at the time. He’d growl at me and snarl during breakfast.’ Pauline finally consulted another doctor, who reassured her that the night sweats would probably become less intense and disappear over a few years. She explained the situation to her husband and discussed ways of minimising the night-time disturbance -including fewer bedclothes, more fresh air in the bedroom, and a spare nightgown in the bathroom, just in case.

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Studies of large groups of women in Western countries indicate that about 70 per cent experience menopausal problems they regard as moderately distressing. A further 10 per cent of women describe their symptoms as severe, and 20 per cent get through the menopause with barely any disturbance.

In some women the signs of menopause last a few months, in others for two or three years. About a third of women are still experiencing distressing problems five years after their last period, and about a fifth have disturbances including hot flushes for a total often years. In general, you will be relieved to know, the severity of symptoms decreases with time.

The place of hormone measurements

Even before your menstrual periods become noticeably irregular, there are subtle changes going on in your ovaries. Studies involving the monitoring of women’s sex hormones over many years show that there are small shifts in hormone levels for about ten years before the last menstrual bleed. This contrasts with the view held by many women that menopause is a relatively sudden life change.

Denise, for example, regarded menopause as a swift transition, since she was keenly aware of changes for only a little more than a year. ‘I was shocked when my always-predictable menstrual cycle went haywire. Instead of five days, I was bleeding for eight days and my cycle got longer. Then things went back to near-normal for a while, before I had bleeding and spotting for nearly two weeks and another long cycle. This sort of irregularity continued for about fifteen months, including a month when I had nineteen days of bleeding and spotting with just two days relief in the middle. I have a theory that this irregular bleeding helps women adjust to menopause in a positive way. I mean, when I looked back and could see that menopause had occurred, I was truly relieved that my body had become predictable once again.’

By the time symptoms are obvious, sex hormone levels can be fluxing significantly from day to day. Interpretations of hormone measurements at this time are notoriously misleading, which is why most doctors prefer to rely on symptoms as the most useful guide to the stage of menopause. In a world where we rely on tests in so many areas, this may seem unsatisfactory. But the fact is that despite sophisticated hormone measuring systems, there is still no test to show that menopause is occurring or to predict just when the last menstrual bleed will take place.

There are some situations in which hormone tests can be very helpful indicators of what is happening to the reproductive system. These include the following:

after a woman’s own hormone production has stabilised and her menopause is confirmed;

in women who have had a hysterectomy or an artificial

menopause and are experiencing distressing symptoms; and in women who have been given sex hormones in the form of implants.

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There appear to be two distinct subgroups within IBS patients. The first group suffer from mild diarrhoea most of the time, often with pain, and sometimes with brief episodes of constipation. The second group suffer from constipation for some or most of the time, with bloating, and occasional bouts of mild diarrhoea. They may also suffer pain. For people in this second group, food sensitivity is unlikely to be at the root of their symptoms. For those with chronic diarrhoea – the first group – food sensitivity is worth investigating, especially if they have bloating and wind as well. Some studies have shown that as many as 70 per cent of IBS sufferers may be food-intolerant.

Alternative explanations for IBS are very thin on the ground. The most widely accepted theory is that the complaint is usually psychosomatic. Another theory suggests that lack of fibre in the diet is responsible. Although this idea is now largely discredited, extra bran and other bulk-forming agents are still prescribed for IBS, regardless of whether diarrhoea or constipation is the main symptom. The latter might be helped by this strategy, but not the former. Indeed, there is evidence that some people with IBS are made worse by eating bran, suggesting a sensitivity to wheat or other grains.

Exactly what goes wrong in IBS is far from clear. In many cases it may be that the muscles of the gut are contracting too much, or too little, or are simply un-synchronized. The muscles that control the bowel are smooth muscles, like those in the bladder and the bronchi (the tubes leading to the lungs). Some patients with IBS have to urinate frequently, and this can be a sign that smooth-muscle spasms are at the root of the symptoms, although frequent urination can also be a straightforward psychological problem.

What causes these spasms? It could be an effect of the sympathetic nerves, if IBS really is psychosomatic. Or it could be mediators released by mast cells (see p26) if there is a true allergic reaction. The term ‘asthma of the gut’ is sometimes used to describe this sort of reaction – in just the same way as there are spasms of the bronchial muscles, producing asthma, there could be spasmodic contractions of the smooth muscles of the gut, producing diarrhoea.

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Poor blood circulation can be helped with a hot water bottle or bed warmer if you cannot warm up naturally. Better still, take a foot bath, or alternate hot and cold baths, to warm your feet. A warm shower or bath is recommended when the body has cooled down considerably and just does not get warm. If you do have poor circulation, never go to bed with cold feet because they can keep you awake for hours. In that case it is better to make the effort and have a warm bath.

Sleeping drugs are the worst thing anyone can take because they do not cure insomnia, unless you use natural remedies. A person who does not subject himself to the laws of nature as regards sleep and rest can become a slave of chemical drugs when constantly resorting to sleeping pills.

Salutary sleep means learning to go to bed early. Soft harmonious music, not loud noise, may send you to sleep, and uplifting reading has a calming effect, in contrast to some exciting television entertainment. Quietly meditating on the deeper meaning of life can free us from the sickening happenings of our times and help us find the necessary rest.

So then, salutary sleep is based on many small necessities and requirements. Give due consideration to them before you consult your doctor about insomnia, because the answer to your problem is generally to be found simply by observing them.

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First thing in the morning I would do my breathing exercises, repeating them at noon during my lunch hour and again at night before going to bed. I began to sleep better, as the intensive breathing exercises gave me a feeling of pleasant tiredness and relaxation. Sleep became more restful and worries, sorrows and anxieties were no longer able to wake me up in the middle of the night. What a marvellous thing it is that breathing exercises have such a profound effect, even being able to influence our mind!

From a physical point of view, my abdominal muscles seemed to be the first to benefit. They became stronger, my diaphragm developed and my digestion improved. I no longer felt any trace of pain and the inflammation which had plagued me for weeks disappeared.

No doubt the natural remedies I took also helped, but without the breathing exercises it would have been difficult to achieve such success.

Some time after this experiment I saw a chiropractor, who was a friend of mine. The X-rays he took showed a normal spine, no arthritis, in fact, no signs of degeneration. Happily he assured me that my diaphragm muscles were exceptionally well developed, better than average, which I attributed to the breathing exercises. Slowly, I began to realise that the exercises had contributed to relieving the mental pressures that had bothered me. It only took five, ten or fifteen minutes each time, but eventually I began to feel more cheerful. It was now easier for me to bear the problems that had weighed so heavily on my mind. Light and sunshine entered my life once more. Indeed, in my case, ‘breathing meant life’!

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Generally speaking, coffee has the dilatory and stimulating effect described above; however, I learned an interesting fact with regard to coffee as the Arabs drink it. It surprised me that it can be prepared in a way that is much less harmful than the coffee made in the European or American home. In fact, I was quite astonished to see that the usual stimulating and insomniac effect was barely noticeable when I had coffee in Arab lands.

The Arabs serve it as the Turks do, in little cups together with the grounds. As a rule, they do not keep it roasted and ground but prepare it when the guests arrive. They roast the beans and grind them shortly before use, bring the ground coffee rapidly to the boil, let it bubble briefly, and pour a little cold water over the froth to settle. Then it is served very strong and thick with plenty of sugar.

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Since reports continue to circulate that seek to discredit natural foods and justify the use of denatured, refined products, it is high time that we clarify the question of sugar once and for all, so that the consumer can be sure of what is genuine and wholesome, and what is misleading and false.

The goodness of fruit sugar is not in any doubt, but when you buy dried fruit take care to select only the produce that is not sulphurised, bleached or denatured in any other way. Nothing but natural, pure fruit guarantees the benefits we intend to derive from it in the first place.

So what do we mean by ‘grape sugar’, as referred to in this book? We refer to the genuine sugar made from grapes, the condensed pure grape juice made from vine-ripened grapes. The manufactured grape sugar is artificial, but the genuine article can be described as nutritive grape sugar or grape concentrate. This syrup can also be made from raisins, sultanas and currants. It is by far the best sweetener available, in many ways equal to honey and in other respects even superior to it because some people cannot take honey, whereas practically everyone can tolerate real grape sugar.

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You can use your imagination to create quite a variety of sandwiches. Serve wholegrain (wholewheat) bread or crispbread, lightly spread with butter, then perhaps just a touch of vegetable extract such as Herbaforce or a yeast extract. A variety of fillings can be used, such as curds or cottage cheese mixed with chives or some other culinary herb. If you like garlic, chop some finely or mince it and spread it on the buttered bread. Garlic, chives and watercress go very well together in a tomato sandwich and so does finely chopped onion in place of the garlic. Grated carrot and a little horseradish is also a tasty combination. There is almost no end to the variety of sandwiches that can be prepared according to your taste and preferences. Herbs mixed with soft cheese and a little cream can be spread on bread or eaten with potatoes boiled in their skins. In the spring, radishes are a welcome addition to the sandwich menu, but they should be used sparingly because they are quite strong and too many can overstimulate or even irritate the liver. The resulting upset would be contrary to the objective of a health diet. Small cucumbers, thinly sliced, are delicious in a sandwich, and even white cabbage, also finely sliced, tastes surprisingly good.

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