In the New Zealand workforce there are approximately 400,000 women in the menopause age bracket, and in a recent study it was revealed that 70% of those women have thought about leaving their jobs because of the symptoms of menopause. It’s a taboo subject in the workplace that is not often acknowledged, and women experiencing symptoms of menopause feel uneasy discussing it.

While menopause is actually just one time point in a woman’s life – one day 12 months after a woman’s last period – the lead-up to menopause (perimenopause) and post-menopause can last for years. Some women sail through these years, but many others have a tough time, with multiple symptoms that have a debilitating effect on their quality of life. Common symptoms are hot flushes, night sweats, insomnia, brain fog, heart palpitations, fatigue, poor concentration and memory, bladder and urinary issues, menstrual disturbances, muscle aches and pains, midline weight gain, itching skin and headaches. Peri- and post-menopause can often be the first time in a woman’s life that she experiences low mood, low confidence, anxiety or depression.

These health issues start about the age of 45 to 55 years and can be ongoing for up to four to ten years, which is a long period of a working woman’s life. An American study found that nearly 50% of working women aged 45 to 60 found it difficult to manage their menopausal symptoms at work. At these ages, women are at a particularly valuable stage in their career, with significant senior-level knowledge and experience. Women aged in their late 40’s and 50’s are often in positions of responsibility, acting as role models and mentors to the younger generation of workers. But their home lives can also be at a demanding stage – women in this age range often find themselves caring for children, grandchildren, parents, spouses or partners, who may be disabled, sick or elderly. Some women struggle so much with their menopausal symptoms and combined responsibilities that they have to leave their jobs.

While attitudes are changing, our society still does not view being an older woman as a positive thing or value the wisdom that comes with age. Menopause is a topic that is made fun of, and there is the stereotype of the older woman being ‘past her prime’. Like mental health issues used to be, menopause is not talked about, with the subject remaining taboo or shameful alongside a lot of silence and misinformation. Apart from pregnancy, breastfeeding and childbirth (and more recently miscarriage), the management of gender-specific health issues and how they affect a woman’s work life are rarely discussed. Many women feel uncomfortable disclosing menopause-related health issues to employers, who can often be male or younger than they are.

With people in menopause – the fastest growing workforce demographic it is a great time to start having conversations about menopause in the workplace. Menopause is a life stage that may need additional support. For workplaces to become menopause-friendly there needs to be greater understanding of the health issues that women face at this time in their life.

One of the benefits of the 2020 pandemic has been the raised awareness of both mental health in the workplace and flexible working conditions. What we have learnt about these topics can also be applied to menopause in the workplace. There are benefits to businesses paying attention to the needs of their female employees who may be having difficulty with their menopause transition. Keeping women in work will decrease recruitment costs, and employers will be better able to attract experienced talent.

Some suggestions for support at work:

• adding resources on menopause to the company intranet
• adjusting deadline expectations
• reviewing leave policies
• access to medical, health and wellbeing services
• flexible working hours
• a quiet place for work and/or short breaks
• noise cancelling headphones
• uniforms in natural, non-synthetic fabrics
• adjustments to work temperature control and ventilation
• cold drinking water
• ready access to shower and toilet facilities
• the ability to sit down rather than stand for long periods.

Raising awareness of the menopause transition helps women understand that what they are going through is a normal life stage, helps everyone in the workplace understand the symptoms and how they can impact a person’s wellbeing and working life, and can enable women to access better support.

If you are experiencing perimenopause or post-menopause, talk to your doctor or pharmacist about treatments or options that may help.

Read more article related to menopause here.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

Menopause and the lead-up to it (called perimenopause) is a time of huge change for women, both physically and mentally. While some women sail through this change, there are many others who suffer a range of symptoms that can have a debilitating effect on their quality of life.

As women age the two hormones produced by the ovaries, progesterone and estrogen, start to decline. Periods become erratic, heavier or lighter and then eventually stop altogether. Symptoms occur as the hormone levels fluctuate within a monthly cycle and start to decrease over time. Common symptoms include mood swings, hot flushes, trouble sleeping, anxiety, weight gain, vaginal dryness, night sweats, trouble concentrating, hair loss, irritability, and urinary problems. Fortunately, there are a range of treatment options and lifestyle choices to help ease this transition.

Hormone replacement therapy (HRT) is medicine that contains estrogen and progesterone to replace the hormones that a woman’s body stops producing after menopause. HRT can help relieve hot flushes, night sweats, vaginal dryness, thinning vaginal walls, bladder infections, mild incontinence, aches and pains, insomnia, memory loss, mood disturbances, decreased libido, palpitations, hair loss, and dry, itchy eyes. It comes in the form of tablets, patches or cream. For women with a uterus, the HRT they take will include both estrogen and progesterone. Taking estrogen only can overstimulate the cells lining the uterus and progesterone is used to counteract the risk of developing endometrial cancer. For women with no uterus (ie women who have had a hysterectomy), HRT will be an estrogen-only formulation. Vaginal estrogen therapy is often used for women that have more local symptoms such as vaginal dryness.

Added benefits of taking HRT are a decrease in the risk of diabetes, osteoporosis, bowel cancer and cardiovascular disease.

Common side effects of HRT are bloating, nausea, breast tenderness and breakthrough bleeding. There are long-term risks to consider including venous thrombosis, a small risk of breast cancer if used for more than five years and a very small increase in the risk of ovarian cancer.

Lifestyle changes that can make the symptoms of perimenopause and menopause easier to tolerate regardless of whether you take HRT or not are regular exercise (just not too close to bedtime), decreasing or eliminating alcohol, regular meditation or yoga, limiting caffeine consumption to mornings only, mindfulness, cognitive behavioural therapy (CBT), stopping smoking and eating a wholefood diet with a high intake of fruit and vegetables. It is very important to manage stress and any other chronic health conditions as well as maintaining a healthy weight. Lubricants can help relieve vaginal dryness and Kegel exercises can help strengthen pelvic floor muscles. For sleep disturbances, practicing good sleep hygiene techniques each night, magnesium supplements and a trial of the sleep hormone melatonin can help. Your doctor may recommend other prescription medicines such as anti-depressants for anxiety or mood disturbances.

There are complementary therapies and medicines available to treat perimenopause and menopause symptoms however there is little evidence to suggest these are any better than placebo. Most natural alternatives will only help one symptom at a time. Saint John’s Wort can help with mood swings and mild depression but won’t help with hot flushes. It can interact with several other medicines. Phytoestrogens are found in all plants but are highest in legumes such as beans and soy foods. Some women find these helpful but scientific studies don’t have strong evidence to show that they work. The decision to start HRT does not depend on a woman having gone through menopause. Perimenopause can start as many as ten years before menopause, in the late 30’s and early 40’s. Some women think they are too young or that their symptoms aren’t severe enough to start HRT, however, I am a strong believer that all people deserve a good quality of life and if that is suffering then it is time to do something about it.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

The technical description of menopause is “a point in time 12 months after a woman’s last period”. The time of life this happens can vary but it usually occurs between 45 and 55 years of age. Menopause can also happen at any age if the ovaries are removed.

Changes to the monthly cycle may start a year or two prior to the actual menopause. Doctors sometimes call this the ‘menopause transition’ or ‘perimenopause’.  At this time there might be gaps of several months when a woman thinks her periods have stopped and then she unexpectedly gets another one.

At this time of life there are often other changes happening for a woman like caring for aging parents or children leaving home. There are physical changes like your waist getting larger and your skin becoming thinner. People also report more achy joints after menopause. Some of these changes experts cannot agree if they are to do with menopause or simply an aging body.

What to expect
Around the time of the menopause a woman might start to get hot flashes (hot flushes) where the body and face heat up very quickly. This sometimes wake the woman at night. Some people experience few or only low grade flashes; for others it is a big concern. Research shows that around 80% of women experience some hot flashes around this time. Hot flashes wake some women several times per night leading to sleep disturbances, exhaustion and irritability.

Painful sex is the second most common symptom after hot flashes. This is caused by the vagina becoming drier and the lining of the vagina getting thinner. The vagina lining then breaks and tears. There is also increased risk of infection in the vagina and urinary tract.

Insomnia occurs in up to half of women during the menopausal transition. Women with insomnia are more likely than others to report problems such as anxiety, stress, tension, and depressive symptoms.

During menopause a woman may become forgetful. Doctors are uncertain if the forgetfulness is to do with the reduced hormone levels or to do with not enough sleep (due to hot flashes). Around 20% (1 in 5) women experience depression at menopause.

Some women experience panic attacks for the first time when they are menopausal. Women who have previously had panic attacks might find these get worse at this time.

Treatments
The good news is that there are treatments to help with all of the above.

For hot flashes that are really bothersome your doctor can prescribe hormone replacement therapy (HRT) which is often now given as a patch that you stick to your skin. There was some controversy about HRT a number of years ago. It is now accepted that HRT is safe in most menopausal women if it is started within 5 years of menopause and before the woman turns 60yrs old.

Some women choose to not use HRT. For some there are health concerns that mean the doctor cannot prescribe HRT. For these women the European Menopause and Andropause Society suggest non-hormonal treatment such as plant oestrogen (natural medicines) as an option. These can be purchased from a pharmacy without a prescription and some women prefer to try these first before asking their doctor about hormone replacement treatments.

If you experience painful dry vagina, your doctor can prescribe an oestrogen cream or pessaries to insert into the vagina to keep the lining healthy and strong. Water based lubricants prior to sex will also be helpful.

Menopausal insomnia is shown to be related to low oestrogen. Being prescribed HRT improves sleep. This is especially true if the insomnia was related to hot flashes. Some women are also prescribed short term sleeping tablets or try natural sleep products. Vitamin D supplements have been shown to half the number of women experiencing depressive symptoms during menopause. Doctors may also prescribe medicine to reduce symptoms of anxiety or panic attacks

Some doctors have special interest in a particular health area (sports medicines or babies or asthma). At this time of huge change in your life it is important that you work with someone you feel comfortable with. If you find your usual GP is not interested or not up to date on menopause you could ask to be referred to someone who specialises in menopause. Alternatively there might be another doctor in the practice or another doctor in your area that you find easier to discuss your concerns with.

Written by Linda Caddick

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

What is the menopause?

Perimenopause follows the fertile stage of a woman’s reproductive life and starts about the age of 40. For the next 10-15 years, ovarian function and hormone production slowly decline. Periods become irregular and then stop altogether. Menopause is the term for when it has been one year since a woman’s last period. When the ovaries stop producing oestrogen, this function is taken over by the adrenal glands which convert androgen to oestrogen with the help of fatty tissue and muscle. The timing of this changeover phase varies from one woman to another meaning that there is an enormous variation in time and symptoms. For many women this transition or “change of life” is not easy and there are physical, mental and emotional changes that can be very disruptive and difficult to manage. However, many women find this stage in their lives liberating.

Bone and heart attack after menopause

There is an increased risk of heart disease and osteoporosis in post-menopausal women. Post-menopause is considered to be the time after periods have stopped for one year. Oestrogen is important for bone health and strength and lack of this can lead to bone thinning and fractures. Oestrogen also protects women from cardiovascular disease before menopause so that the risk of heart disease and strokes catches up to that of their partner’s and male friends and family after menopause.

What are the symptoms?

You may have all or none of these but most women experience some of these symptoms:

• Changes in periods becoming lighter and less regular. Heavier and more frequent bleeding is possible but must always be investigated further
• Hot flushes and night sweats: an overpowering sense of heat, often followed by feeling clammy and cold
• Sleep problems because of flushes, sweats and changes in brain chemicals that control sleep
• Mood swings: feelings of being unloved or depressed are related to hormonal changes affecting brain chemicals; also this may be a time when children leave home and parents are elderly and in need of care, which can exacerbate hormonal-induced emotions
• Vaginal dryness: the lining of the vagina and bladder entrance becomes thinner, drier and less elastic, which can make intercourse uncomfortable and lead to vaginal and bladder infections and loss of libido
• Thinning of the skin all over your body
• Loss of tissue “plumpness” due to dryness and loss of collagen
• Increased abdominal fat (middle-aged spread), caused by changes in your body’s nutritional needs and how it stores fat
• Loss of hair where you want it and appearance of “whiskers” where you don’t, often on the chin.

1. How to tell when menopause has started

• When your periods start to become irregular and possibly flushes and night sweats begin
• Your doctor may take blood tests to check for changes in hormone levels.and investigate heavy or frequent bleeding.

2. Treating symptoms

• Take supplements like B vitamins to help with mood swings; vitamin D and calcium for bone strength
• Vaginal oestrogen-containing creams or lubricants can help relieve vaginal dryness
• Phytoestrogens are naturally occurring oestrogens in some foods like soybeans, chickpeas, nuts, whole grains, seeds and some fruits and vegetables (green beans). These foods are also high in minerals like magnesium which is also thought to help reduce menopausal symptoms
• Black cohosh is a herbal product, which helps many women with symptom relief
• Try an alternative approach; visit a homeopath, try herbal remedies
• Avoid any known triggers for hot flushes, like coffee, red wine, spicy food
• Non-hormonal medication options for severe symptoms include the serotonin-stimulating antidepressants.

3. Hormone replacement therapy (HRT)

HRT is the replacement of naturally produced oestrogen and progesterone, with another source in the form of creams, tablets, patches or implants. HRT helps relieve menopausal symptoms like flushing and sleep problems and it also protects against thinning bones. Prolonged use (over five years) has been linked with increased risk of breast cancer and other health problems. The decision to take HRT should be made in consultation with your doctor and depends on the severity of symptoms.

4. Look after your bones

Bones need calcium for strength (at least 1000mg recommended) and vitamin D to help them absorb calcium, so make sure you have enough of both in your diet from low-fat dairy foods, leafy green vegetables, and nuts and fish with edible bones like salmon and sardines. A little bit of sunlight is also good for bones as it helps you manufacture vitamin D. Enough calcium is hard to achieve in a normal diet and supplementation may be needed.

Weight-bearing exercise such as walking and resistance-based exercise such as working with weights are both important for maintaining bone mass.

Biphosphonates are prescription medicines you can take to protect bone structure and prevent bone loss.

5. Lifestyle approaches

• Use exercise to help you through difficult times; include yoga, pilates and Tai Chi, which help maintain muscle strength and flexibility and keep stress under control.
• Don’t smoke, as smoking increases the risk of osteoporosis and heart disease
• Fight middle-age spread with regular exercise and a sensible diet.
• Aging skin is thinner and more sensitive, so take care of your skin, keeping it moist with gentle moisturisers and avoid harsh soaps and detergents.
• Be positive and mange your life to accommodate the changes you are experiencing, keep active and use strategies to help you cope with symptoms.

What is testosterone?
Testosterone is a sex hormone essential for male growth and development. This hormone is important for male:

• muscle size and strength
• bone growth and strength
• sperm production
• libido
• appearance of facial and pubic hair
• deepening of the voice
• development of the penis and testes

Women need testosterone too – just not in the same amounts as men! It is made in their adrenal glands and ovaries and has an important role in women’s health and brain function – maintaining ovarian function, bone strength, libido and mood.

 

Is ‘male menopause’ a thing?
While nowhere near as dramatic as the sudden drop in estrogen that happens as women approach menopause, men will get a gradual drop in their testosterone level as they age – about 1 to 2% per year after the age of 40 as their testes start to produce less of this hormone. Not all men will experience symptoms, which are slower to appear and more subtle than the symptoms women experience through perimenopause and menopause.

Other causes of low testosterone apart from the aging process can be significant stress, vigorous exercise, kidney disease, alcoholism, cirrhosis of the liver and sleep deprivation. The testes can be affected by direct injury, tumours, radiotherapy and chemotherapy.

In women who have had their ovaries removed, testosterone levels will be low, and also if they suffer from any disease of the adrenal glands, pituitary or hypothalamus.

How would I know if I have low testosterone?
You would need a blood test to check this as some of the signs and symptoms that come with a low testosterone level can also be caused by certain medications or by having a high body mass.

Common symptoms of low testosterone in men are:

• loss of body and facial hair
• loss of muscle mass
• hot flushes
• irritability, poor concentration, depression
• weight gain
• less energy
• increase in breast size
• low libido, impotence
• brittle bones, increased fracture risk
• infertility, small testicles, low sperm count.

For women:

• low testosterone levels result in low libido
• decreased bone strength and muscle mass
• poor concentration
• depression

 

Is there a male version of HRT to treat low testosterone?
Yes, there is fully subsidised treatment called Testosterone Replacement Therapy (TRT) in New Zealand for low testosterone (hypogonadism). Oral, injectable and transdermal forms of testosterone are available. However, to be offered this treatment, low testosterone levels need to be clinically established as consistently low, and the signs and symptoms shown to have a significant impact on the quality of life, as well as any possible reversible causes to have been identified and worked on first.

 

What about for women?
Testosterone is now widely used in other countries to treat peri- and menopausal women alongside the other well-known hormones of estrogen and progesterone. As yet there is no fully funded or approved testosterone treatment for New Zealand women. The approved, funded forms of testosterone are all produced in the male physiological range, in doses appropriate for men only. In New Zealand, prescribers can only prescribe testosterone to women as an “off-label” and unapproved medicine, and there can be significant cost to this.

 

What are the benefits of TRT?
TRT can improve mood, well-being, cognitive function (memory and executive function), energy levels, libido and sexual function for both men and women. It also increases muscle and bone mass. For women it can improve the tissues and organs of the pelvis. It can be used to help the vulvo-vaginal and urinary tract symptoms in menopause (testosterone is an important hormone for vulva skin health, thickness and elasticity and to prevent vaginal dryness).

 

Talk to your healthcare professional about testosterone as an option to consider for:

Men – TRT may be suitable for you if you have symptoms that are impacting your quality of life, your blood tests show consistently low levels of testosterone, and your doctor decides it is an appropriate treatment based on your lifestyle factors and health history.

Women – Testosterone may be an option worth considering as an addition to a well-established hormone replacement therapy regime for post-menopausal women experiencing sexual dysfunction.

The word “tinnitus’ comes from a Latin word ‘tinnire’ which means ‘to ring’. People who experience tinnitus hear a sound which is not related to any external source. While some people tolerate tinnitus well, in others it can trigger the fight-or-flight response as the brain perceives the sound to be important and dangerous.

 

Is the ringing in my ears permanent?
Yes, it might be. There are a wide range of causes for tinnitus, but not all result in permanent ringing. Impacted ear wax, a middle ear infection, perforated ear drum, or a side-effect to certain medications can all cause temporary tinnitus. Once these conditions are sorted, the tinnitus will likely go away.

In some instances, the tinnitus can be permanent. It often happens when there is hearing loss, after prolonged exposure to loud noise, after whiplash or a head injury and it can occur in some medical conditions such as Meniere’s Disease.

Other wide-ranging causes of tinnitus include aging, scuba diving, drinking excess alcohol and caffeine, diabetes, TMJ (temporomandibular joint) problems, high levels of stress, physical or emotional trauma, perimenopause and menopause.

 

What does tinnitus sound like?
Tinnitus has been described in many different ways – a ring, buzz, whistle, hum, hiss, or drone to name a few! The sound can be constant, intermittent or pulsing. It can feel like it is coming from inside the head or from a distance away. Some people may only notice their tinnitus in very quiet places or at night time. It can be in one or both ears.

 

What is making the noise?
Our bodies make noise all the time. These noises are called ‘somatic sounds’ and we don’t usually notice them because we are always listening to external sounds. If something blocks the external sound (like ear wax or fluid in the inner ear), our attention is drawn to the somatic sound.

With permanent tinnitus, the sound may be caused by damage to the delicate hair cells of the cochlea in the inner ear. These cells, when healthy, help to transform sound waves into electrical signals that travel via the auditory nerve to the brain. With damage to these cells, the brain doesn’t get the right sounds and neurons act abnormally to give the illusion of sound ie tinnitus. A bit like phantom limb pain in an amputee, the brain produces an abnormal sound to counteract the missing or decreased input.

 

The tinnitus is driving me nuts, what can I do to make it go away?
Some people react mildly to the development of tinnitus, others find it extremely intrusive. It can cause such significant distress for some that their quality of life decreases dramatically and suicidal ideation can occur. The sound can interfere with concentration and sleep, and is often associated with anxiety and depression, or can make these conditions worse.

Fortunately, much can be done to make tinnitus more manageable and less noticeable:

• Sound therapy uses specific noises to promote habituation – where you eventually don’t notice the noise as much and your brain recognises the sound isn’t actually harmful to you.
• Stress reduction and sleep hygiene are absolutely essential as stress, anxiety, fatigue and insomnia all worsen the condition.
• A healthy diet and physical activity to improve your general health is important.
• Treating insomnia, depression, anxiety or pain with medication and/or psychotherapy such as CBT can improve these conditions.
• Jaw clenching, teeth grinding, prior injuries to the head or neck or neck muscle tension can make tinnitus more noticeable. Massage therapy and stretching can help relieve these issues.
• Treat any underlying physical causes such as ear wax or infection.
• Mask the sound by using background noise. A sound that is similar in pitch and character to the tinnitus sound can help. Fan and nature sounds can be better than TV, music or radio. Having the volume just quieter than the actual tinnitus sound allows habituation.
• Get a hearing assessment with an audiologist if hearing loss is the suspected cause. Hearing aids can help to alleviate tinnitus.

 

If you think you may have tinnitus, seek help early as it can be a sign of other health problems. Get checked for any possible physical causes and rule out hearing loss. If chronic, tinnitus can become less noticeable and more manageable over time.

Nearly all cervical cancers are caused by infection with the human papillomavirus (HPV). This virus infects cells on the cervix and causes changes that over time can lead to cancer. Knowing what can cause this cancer has been a valuable tool for medical researchers and scientists in terms of helping to prevent women from dying from cervical cancer.

In New Zealand, the combination of a successful cervical screening programme (regular smear testing) as well as a vaccination programme to protect young people against HPV, means that the risk of dying from cervical cancer is markedly reduced compared to other cancers. Cervical cancer usually grows very slowly. If caught at an early stage it is very treatable, but it can be a serious disease if allowed to grow bigger or spread into surrounding tissues. In New Zealand there are still around 160 women diagnosed with cervical cancer each year, and about 50 of these women will die from it. Cervical cancer can affect anyone with a cervix. This includes women, non-binary people, trans men or intersex people. If you have had a total hysterectomy where your womb and cervix have been removed you cannot get cervical cancer.

You can get infected with HPV from sexual activity. There are several strains of the virus, some of which are higher risk and can cause different types of cancer such as head, neck, cervical, anal and vulval cancers. Other strains can cause genital warts. HPV infection is very common, with up to 80% of adults being infected at some point in their lives.

The HPV vaccination programme started in 2008 and is for people aged 9 to 26 years old. The vaccine protects against some of the higher risk HPV strains that can cause cervical cancer. Having the full course of the vaccine helps to protect people from developing HPV infection and therefore decreases the risk of cervical cancer and other diseases caused by HPV. Children in Year 8 at school are offered the vaccination through a school-based immunisation programme (and it is also available through your GP, health centres and some Family Planning Clinics).

Regular smear tests can detect changes on the cervix before they turn into cancer. It is very important that smear tests are done at least every three years, or more often if you have a confirmed HPV infection or have had abnormalities picked up in a previous test.

Usually, there are no symptoms in the pre-cancerous and early stages of cervical cancer. It is often only when the cancer has gone undetected for some time and has grown into surrounding tissue, that symptoms start to occur. Symptoms to look out for are:

• abnormal vaginal bleeding (after sex, bleeding or spotting between periods, heavier, longer periods, or bleeding if you have been through menopause)
• pain in the pelvic area (tummy, pelvis, lower back)
• pain after sex
• unusual vaginal discharge
• blood in the urine
• problems urinating or having a bowel motion.

While regular cervical screening and HPV vaccination are the best means of prevention against cervical cancer, other prevention measures are using condoms during sex, stopping smoking (as it weakens your immune system), and eating a balanced diet to support your immune system. Treatment for cervical cancer depends on what stage it is found and can involve surgery, radiotherapy and/or chemotherapy. Early-stage cancer is usually treated with surgery. A procedure called a cone biopsy cuts away the small area of cancerous tissue, leaving the rest of the cervix intact. This way, you can still become pregnant in the future. More invasive surgeries may be required which can involve removal of the cervix and surrounding tissue, or even a hysterectomy where the cervix and uterus are removed. Radiation therapy is often used as the primary treatment along with chemotherapy for locally advanced cervical cancer to kill cancer cells. These treatments can also be used after surgery if there is a chance that the cancer could come back.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

Our body’s way of cooling us down when we get hot, stressed or after exercising is to sweat. Sweat is a weak, salty solution produced in sweat glands found all over the body but especially in the palms of our hands, soles of our feet and under the armpits. Our nervous system triggers the sweat glands in our skin to produce this fluid to cool our body. Sweat evaporates off the surface of our skin and provides a cooling effect. If the nervous system becomes overactive, sweat glands can be triggered to release fluid even without exercise, stress or increased temperature.

Excessive or uncontrolled sweating is called hyperhidrosis and can be quite embarrassing and distressing for the sufferer. The condition can affect people’s social lives and confidence and also result in annoying complications such as eczema and skin fungal infections. Excess sweating can happen because of a number of reasons such as the side effect of a medication you may be taking or from an underlying medical condition.

There are two types of hyperhidrosis – focal hyperhidrosis (where people tend to sweat only in certain areas of the body such as hands, armpits, feet and face and generalized hyperhidrosis (which happens usually due to a medical condition and in this case excess sweating occurs over the whole body).

There is quite a long list of medical conditions that can cause excess sweating, so it is definitely worth a trip to your GP to be checked out to rule out the following: low blood sugar, infection, thyroid disorder, diabetes, chronic anxiety, perimenopause/menopause, heart attack, nervous system disorder and some types of cancer. Obesity, spinal nerve damage and medications (such as alcohol, caffeine, some antidepressants, opioids and steroids) can also cause excess sweating.

Treatments for hyperhidrosis range from general self-help measures such as wearing loose fitting clothing, to surgery where the sweat glands are removed. Antiperspirants are often a great help in treating excess sweating and are the first line of treatment. These are different to deodorants which only disguise unpleasant smells and have no effect on decreasing perspiration. Anti-perspirants contain aluminium salts which actually decrease sweating. Carry a spare set of clothes to change into if needed, and wear non-synthetic fabrics such as silk and cotton which are more breathable than synthetic fabrics like nylon and polyester. Wear socks that absorb moisture and wear a different pair of shoes each day to make sure shoes are completely dry before wearing again. Foot powders can also be useful for sweaty feet and armpit or sweat shields will protect clothes. Try to avoid alcohol and spicy foods as these can make you sweat more. Use soap substitutes as these are gentler on skin.

Behaviour therapy and relaxation techniques can help to decrease anxiety that causes or adds to excessive sweating. There are some medicines such as antidepressants and nerve blockers that can decrease sweating. Botulinum toxin (Botox) is another medicine used (not just for smoothing out wrinkles!) as when it is injected around sweat glands it can decrease the amount of sweat produced. Botox blocks the chemical signals from the nerves that stimulate the sweat glands. If the glands receive no signal, then no sweat is produced. This is a very effective treatment and often one session is all that is required, and can last up to seven months.

Iontophoresis is a medical treatment where a mild electrical current is delivered to the affected area to stop sweat glands producing fluid. As previously mentioned, and as a last resort, surgery can be used to either sever the nerves to the sweat glands or completely remove them.

There are many levels of treatment for excessive sweating and it is important not to suffer in silence with this condition.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

Urinary incontinence is the loss of bladder control. There are different causes but the end result is wet pants and often embarrassment.

Symptoms of incontinence can range from the occasional leak from coughing or laughing to a constant dribble or a total emptying of the bladder before you reach the toilet. Incontinence is more common in women due to differences in structure of our urinary tract.

Causes:

• Incontinence is usually associated with childbirth, menopause or aging.
• Sometimes a physical condition causes loss of bladder control. Things like a prolapsed uterus from childbirth or aging could be the cause, and this might need surgery.
• Needing to go suddenly and not being able to get to the toilet in time is known as ‘urge incontinence’. There are a range of causes for this including neurological conditions that interfere with the messages between the bladder and the brain and so you don’t know you need to go toilet, or don’t know in time. This might be Parkinson’s, multiple sclerosis, brain tumour, spinal injury or a stroke.
• Physical difficulty in getting to the toilet e.g. arthritis or a stroke may make getting to toilet slower.
• ‘Overflow incontinence’ is when the bladder does not empty properly and so there is a constant dribble of urine escaping.
• Incontinence can be a sign of some disease such as diabetes.
• Prostate enlargement in men can result in incontinence. This might be the common age related enlargement or it might be prostate cancer.
• Being overweight or smoking increases your chance of urinary incontinence. These are also risk factors for many health conditions from cancer or heart attacks to dementia. It is always best to check you keep within the healthy weight range for your height and give up smoking if you are a smoker.

Some things that might cause short term incontinence include alcohol, fizzy drinks, caffeine in tea or coffee and things that are high in sugar (sweet drinks) or high in acid (like citrus fruit. Some medicines might increase your need to go toilet. If you think your incontinence is caused by your medicine talk to your doctor or pharmacist. Loss of bladder control can also be caused by a urinary tract infection or by constipation.

Coping with incontinence
In the short term it is good to wear a pad or absorbent underwear of some kind so that you have the confidence to still go out and know it’s OK to laugh or sneeze. There a specific products for men and women that have absorbency in the appropriate areas. There are products for a light dribble through to total loss of bladder control.

If you are wet a lot of the time you might want to use a barrier cream like cocoa butter to protect your skin from the urine.

Do talk to your doctor about incontinence. They will want to make sure that you don’t have any medical condition causing the bladder problems. They can also prescribe medicines that might reduce your need to go toilet or review your current medicines in case any of them are causing the issue. Depending on the cause and severity of the incontinence the doctor may suggest surgery.

Increase physical activity. Ensure you are walking for a minimum of 30 minutes every day. This will help with general health as well as your incontinence.

Keep your bowel movements regular; eat plenty of fibre. The bowel and bladder are next to each other. When you get constipated it will affect your bladder.

Make lifestyle changes such as not rushing to the toilet as soon as you get home. Try to go before you start heading home so you don’t have to rush.

Longer-term there are pelvic floor muscle exercises that will increase your control of your bladder. This involves strengthening the muscles that hold in the urine. Tighten those muscles as if you are trying to stop wetting yourself. Hold for 5 seconds then release. Do this five times in a row and five times per day. Make sure you are only tightening the muscles that stop you urinating, keep you bottom and thigh muscles relaxed when doing this exercise.

Gradually increase to holding for 7 and then 10 seconds. Increase until you can do this 10 times in a row. Repeat this exercise 5 to 10 times per day. Have specific tasks that will remind you to practice these pelvic floor exercises like every time you are on the bus, every night as you prepare dinner, when you watch TV and when you first go to bed.

Five second hold, five times in a row and then repeat that five times per day. Don’t overdo it to start with. Like any exercise start with a little bit and build up.

Written by Linda Caddick

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

World Osteoporosis Day is on Tuesday 20 October this year. The aims of this day are to raise awareness of how to prevent, diagnose and treat osteoporosis and metabolic bone disease. Osteoporosis is a condition where the bones are weak, brittle and not as dense as normal bone, and are more likely to break. Osteoporosis can cause the bones to become so fragile that a bump, sneeze or minor fall can cause a fracture. These fractures can cause long term disability, reduction in quality of life, unnecessary pain and suffering, and can even be life-threatening.

Bone is a living tissue that is constantly renewed over our lifetime. There is a continuous cycle of new bone being made while old bone is broken down. When we are children and young adults new bone is made faster than old bone is replaced and our bone density is high, increasing until we reach peak bone density in our thirties. After the age of around 35 our bone density begins to decrease and old bone is broken down faster than new bone is made.

One in three women and one in five men over the age of 50 will fracture a bone as a result of osteoporosis. There are usually no symptoms of the disease until a bone is broken and it is often called a ‘silent disease’. Fractures are most common at the wrist, upper arm, pelvis, hip and spine, with the vast majority occurring in people over the age of 65. Loss of height may be one of the only visible signs of osteoporosis. This happens when the vertebra of the spine weaken and compress, causing the spine to curve (called a ‘Dowager’s or widow’s hump). With severe osteoporosis fractures can occur when doing normal things such as lifting, bending or getting out of a chair.

Osteoporosis can be prevented but people need to act early, and take steps throughout their lives to build strong bones and prevent osteoporotic fractures. There are several key points to follow in order to build and retain healthy bones over your lifetime – exercising regularly, eating a bone-healthy diet with adequate calcium, avoiding smoking and excess alcohol, maintaining a healthy weight, finding out about your own risk factors, and getting treated early if you think you may be at risk of osteoporosis.

There are risk factors that contribute to the likelihood of osteoporosis. Being female is one, especially at menopause where oestrogen levels in the body decrease (oestrogen has a protective effect on bone), having a family history of fractures or osteoporosis, increasing age, and immobility. Being below average weight, having an inflammatory condition such as rheumatoid arthritis or inflammatory bowel disease and some medications (prednisone, anti-seizure medicines, some cancer treatments) can all contribute to increased bone loss.

Having a DEXA scan to measure your actual bone mineral density is the most accurate means of diagnosing osteoporosis. Usually the hips and lumbar spine are scanned using very low level radiation to determine this.

The main treatments for osteoporosis are exercise to strengthen bones and supporting muscles, and taking medicines to increase bone density and decrease the risk of fracture. Exercise in the form of weight-bearing aerobic exercise (e.g. running) is very important, however so is resistance exercise (free weights) and posture/balance/strength training such as yoga and tai chi.

Medicines called bisphosphonates (alendronate, risedronate and zoledronic acid) are the mainstay of osteoporosis treatment in New Zealand and decrease the rate of bone loss. Hormone replacement therapy is also used to decrease bone loss and increase bone density. Teriparatide is a synthetic hormone that stimulates bone growth and denosumab inhibits the development of cells that break down bone. Calcium and Vitamin D supplements are often prescribed alongside these osteoporosis treatments .

There are now several online assessment tools available where you can assess your risk of an osteoporotic fracture, one of which is called “Know Your Bones”, developed by Bone Health New Zealand. It’s worth undertaking a quick assessment and getting in touch with your doctor if you think you may be at risk of osteoporosis.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.