Archive for Health Issues

Women’s Coronary Health

womens coronary health

Welcome to February, which is National Heart Disease Awareness Month. But this campaign is not just for the United States: heart disease prevention is the world’s problem, especially with increased sedentary lifestyles and increased fast food intake among adults. Alarmingly, heart disease is the number one cause of death among women.

On February 1st, we were asked to wear red to show support for heart disease awareness. The red dress became a symbol for women and heart disease awareness in 2002. Today, it’s important to recognize the risks for women’s heart disease, and to actively work towards its prevention and cure.

Definition of Heart Disease

Heart disease consists of many disorders that prevent normal heart functioning. Some are congenital (existing since birth) and some develop during a lifetime. Some affect the structure and function of the heart, while some affect the structure and function of the adjoining arteries.

The purpose of Heart Disease Awareness Month is to address the most common, preventable forms of cardiovascular disease, particularly coronary artery disease, or the disorder of the adjoining blood vessels that lead to the heart. Unfortunately, CAD causes these vital arteries to become blocked with plaque, leading to heart attacks and even death.

Women’s Heart Disease Risk Factors

While various types of heart disease are congenital or structural (thereby being less avoidable), coronary artery disease is the result of plaque buildup in vital blood vessels. If the disease is acquired or developed, like CAD, certain factors can cause it or worsen an already existing condition. These include:

  • a family history of heart disease
  • being overweight
  • being physically inactive
  • age (55+/ low estrogen levels)
  • having high cholesterol
  • having high blood pressure
  • smoking
  • having diabetes
  • ethnicity: being African American or Hispanic

Risk factors should be kept in mind, and if a woman has several factors, her odds for developing heart disease increase drastically. Even if a woman has only one risk factor, she should consult with her doctor to remedy a fixable situation.

Heart Disease Prevention

Proper prevention is the best way to avoid developing heart disease. Key areas to focus on include:

  • Keeping physically active: Try to exercise for 30 minutes a day, at least 4 times a week.
  • Maintaining a healthy weight: This lowers the risk for developing diabetes, high blood pressure, and high cholesterol.
  • Lowering stress levels and alcohol consumption: Deal with stress in a positive way (exercise) and not with excessive drinking or smoking.
  • Not smoking: This habit narrows healthy or already clogged arteries, making blood flow to the heart even tougher.
  • Lowering blood pressure and cholesterol levels: This can be done by exercising, lowering stress levels, and eating correctly. Medication can also be used. Cholesterol causes plaque buildup in the coronary arteries, causing coronary artery disease (CAD.) This leads to heart attacks and possibly death.
  • Eating healthy: Consume vegetables, fruits, low-fat poultry and fish, low-fat dairy, and nuts for healthier arteries, which in turn maintain a healthier heart.

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Women and Tension Headaches

women tension headaches

Many women lead stressful, fast-paced lives. It’s no wonder that tension headaches are so common. Just like migraine headaches, tension headaches have specific symptoms, triggers, and risk factors. But tension headaches are muscular, not vascular, and the triggers tend to be physical and stress-related factors.

What are Tension Headaches?

Tension, the most common form of headache, is caused by muscle contractions in the neck, scalp, forehead, and face. Simply, tension headaches are the product of tightening muscles caused by such things as emotional stress or physical straining.

Tension headaches fall into two categories: episodic and chronic. Episodic headaches happen on an infrequent basis, with no specific pattern of occurrence. Chronic tension headaches, on the other hand, occur on a regular basis, at least 15 days out of a one-month period.

Symptoms of Tension Headaches

Tension headaches differ from other types of primary headaches by their degree of pain. Whereas migraine and cluster headaches are usually severe and stabbing, tension-type pain is generally more diffuse (spread out) and pressured. Sufferers might describe the pain as “tightening, dull, and achy.”

Tension headache pain can exist in the head, neck, and even extend into the shoulders. Duration can be as brief as a half hour to as long as several days.

Women with tension headaches don’t experience “migraine-like” symptoms such as nausea, vomiting, or sensitivity to light or sound. These such neurological symptoms differentiate tension headaches from migraine headaches.

Common tension headache symptoms include:

  • anxiety
  • head, face, neck, and/or shoulder pain and “tightness”
  • fatigue
  • insomnia
  • irritability
  • impaired concentration
  • depression

Tension Headache Triggers

Headaches can be triggered by various factors, including:

  • stress/anxiety
  • depression
  • family problems
  • work situations
  • guilt
  • school work
  • poor posture or straining neck muscles
  • eye strain

Risk Factors

Certain situations increase the risk for developing tension headaches. Women who work in stressful, high-pressure fields are more prone to this type of headache. College students can develop them due to the stress of school work. Physical stress can also trigger such headaches.

Anything that causes emotional strain can put a woman at risk for developing tension headaches. Major life changes such as a new marriage, the birth of a child, job changes, separation and divorce, and the death of a loved one can trigger tension-type headaches. Ongoing stress can cause episodic headaches to become chronic. Even experiencing a bout of depression can cause tension headaches.

Physical risk factors include poor posture, stooping, sitting in an uncomfortable position too long, eye straining, and physically straining neck and shoulder muscles.

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Women’s Health Linked to Environment

womens health

On their June 4 2008 post entitled, “Ten Facts on Preventing Disease through Healthy Environments” the World Health Organization (WHO) cites the environment as a major link to illnesses and death: “Environmental hazards are responsible for about a quarter of the total burden of disease worldwide…As many as 13 million deaths could be prevented every year by making our environments healthier.”

Environmental Triggers

WHO cites pollution, workplace hazards, radiation and climate change as chief factors that influence 85 of the 102 categories of diseases listed in the 2004 “World Health Report”. These include cancer, learning and behavioral disabilities, birth defects, reproductive problems, and heart and respiratory difficulties.

Lifestyle Related Problems

“Tens of thousands of chemicals have been released into the North American ecosystem since the Second World War,” reports the Women’s College Hospital in a January 2009 post of their website, Women’s Health Matters entitled, “Environmentally Linked Illnesses and Conditions.”. They suggest that an overload of stressors, common in our fast-paced lifestyle (including sleep deprivation, lack of physical activity, poor nutrition and emotional stress) exacerbate our environmental sensitivities and our vulnerabilities to environmentally-related illnesses and the overwhelming number of different chemicals we are commonly exposed to daily.

Environmental Sensitivities

The Environmental Health Association of Ontario defines environmental sensitivities on the home page of its website as a person’s negative reaction to a substance or phenomenon at a level well below what “normal” people would consider acceptable. These can be triggered by a wide variety of substances from detergents to electromagnetic radiation.

Why Women are More Affected

“Women are affected by environmentally linked illnesses far more than men are,” asserts the Women’s College Hospital. They report that 80 to 90% of those affected by environmental sensitivities, chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia (described as 21st Century illnesses) are women.

Here’s what they suggest are the likely causes:

  • women are more likely to clean and manage the home environment, exposing them more to a variety of toxic substances (e.g., cleaning and laundry products, pesticides, foods, and solvents)
  • women are more likely to use cosmetic products, many of which contain potentially harmful chemicals
  • women react differently than men when exposed to the same toxic substances, based on their differing physiology, physicality and hormonal makeup, their body fat, and general weight
  • women are more likely to live in poverty in North America than men, making them more vulnerable to questionable housing conditions (e.g., exposure to environmental toxins like asbestos, lead-based paint and mould in the home and air pollution near the home.

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Women’s Health Needs Guide

Dr. Nieca Goldberg’s Complete Guide to Women’s Health explores the range of medical problems that might bring a woman to a doctor’s office, from hormonal imbalances to heart disease. The advice provided in the book is geared to realistic expectations. Up-to-date medical information is given in an easy-to-read, woman-to-woman tone of voice.

women health needs guide

Guide to Woman Health Overview

Women today are likely to find themselves under a lot of stress, low on energy, gaining weight, and not sleeping well. The book takes all these factors into consideration.

Some of the information in the book includes;

  • The normal physical changes that can be experienced as a woman becomes older.
  • Treatments for over- and underactive thyroids and hormone issues.
  • The signs, symptoms, and management of type 1 and type 2 diabetes.
  • Facts on fertility, contraceptives, pregnancy, and menopause.
  • Information on good breast health, including preventive breast-cancer measures.
  • A comprehensive heart-to-heart discussion about the cardiovascular system.
  • Dealing with GERD, stomach ulcers, gallstones, BS, IBD, and colon cancer.
  • Strategies for keeping bones strong and fending off arthritis and osteoporosis.
  • Coping with foot and back pain.
  • The importance of diagnosing sleep apnea and insomnia.
  • Revelations about the mind-body connection.
  • Countering stress and relieving depression.

Women’s Guide to Health Discussions

Dr. Goldberg emphasises that women’s bodies are not just small versions of men’s. Women have different medical needs and different ways of relating to treatment. This can result in women not getting the care they need. Women must get in the habit of telling their doctor everything, including:

  • Any symptoms being experienced
  • Medicines and supplements being taken

A woman should ask about the benefits and risks of various treatments and procedures such as chemical peels, Botox and breast implants.

Healthy lifestyles dealing with diet and exercise are geared to realistic expectations.

Taking the Fear out of Women’s Health Issues

The insightful, expert advise provided in the Complete Guide to Women’s Health will empower women and take the fear out of dealing with health issues. In taking charge of their health care and their lives, they will be able to make informed choices while making decisions about what to do about them.

About the Author

Dr. Nieca Goldberg is a cardiologist and a nationally recognized pioneer in women’s heart health. Her New York City practice Total Heart Care focuses primarily on caring for women. Dr. Goldberg is Clinical Associate Professor of Medicine and Medical Director of NYU Women’s Heart Program, the Co-Medical Director of the 92nd Street Y’s Cardiac Rehabilitation Center, a national spokesperson for the American Heart Association’s “Go Red” campaign – an association for which she has volunteered for over 15 years and been a board member in NYC.She was formerly the Chief of Women’s Cardiac Care at Lenox Hill Hospital in New York City.

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Yeast Infections And Candidiasis

Candida albicans is a yeast that normally lives in the intestines. Its function is to break down undigested food particles before harmful bacteria can start growing on them. In most healthy people, the levels of this yeast are kept under control by beneficial bacteria, including Lactobacillus acidophilus.

However, certain conditions can disrupt this balance between beneficial bacteria and Candida albicans. When this happens, the yeast organisms can grow unchecked. The yeast overgrowth starts in the intestines and then spreads throughout the body by means of the bloodstream. This condition, called systemic candidiasis, can be responsible for many different health problems throughout the body.

Is Systemic Candidiasis a New Disease?

Systemic candidiasis has probably existed for as long as we’ve been using antibiotics. It wasn’t recognized before the 1980’s, usually because it mimics so many other diseases and conditions. A person who seems to have chronic sinusitis may instead be suffering from a yeast infection in the sinuses.

Doctors have always diagnosed obvious yeast infections, including vaginitis or thrush. But treatment focused on getting rid of visible symptoms, while ignoring the possibility that a serious hidden infection existed.

What Are The Symptoms Of Systemic Candidiasis?

The symptoms can vary from person to person. Plus, they can be more severe in some people than in others. The most common symptoms of systemic yeast infections include:

  • Chronic fatigue and depression
  • Craving bread and sugars
  • Extreme mood swings
  • Feeling drunk after eating a high-carbohydrate meal
  • Hypoglycemia (low blood sugar)
  • Excessive mucus in the throat, nose, and lungs
  • Chronic fungal infections such as jock itch or athlete’s foot
  • Recurring vaginitis or oral thrush
  • Chronic diarrhea
  • Anal itching
  • Memory loss
  • Bloating and flatulence after most meals

Some people also suffer from the following symptoms:

  • Swelling of the lymph nodes
  • Extreme PMS
  • Night sweats and insomnia
  • Chest and joint pain
  • Blurry vision, along with dizziness or loss of coordination
  • Intense headaches that come on for seemingly no reason
  • Sneezing fits

A person with systemic candidiasis may be very sensitive to damp, moldy places, and extreme humdity. He or she may react strongly to perfumes and colonges, as well as cigarette smoke.

If Candida albicans gets into the urinary tract, cystitis, acute kidney infections, and prostratitis can result.

How Can I Tell Whether Or Not I Have Systemic Candidiasis?

A long history of chronic health problems that seem to have no cause may be a tip-off, espcially if you have one or more of the following risk factors:

  • Prolonged or repeated courses of antibiotics or corticosteroid drugs.
  • Taking birth control pills over a long period of time.
  • A diet made up mostly of processed foods and foods that are high in sugar (this encourages Candida to grow)
  • Chemotherapy, organ transplants, alcohol abuse, multiple blood transfusions, or an extended illness. Any of these can suppress the immune system.

Preventing yeast infections is much easier than treating them. Once it spreads throughout the body, eradicating systemic candidiasis can be a long, difficult process.

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Genital Herpes

What is Genital Herpes?

The Herpes Simplex Virus (HSV) causes a recurrent, incurable viral disease that has two forms,  HSV-1 and HSV-2. HSV-1, generally appears as cold sores around the face–especially the mouth. HSV-2, generally is a sexually transmitted disease that manifests as genital lesions.

Herpes zoster, shingles, is a remanifestation of chicken pox which is herpes varicella.

Can I know when I’m infectious?

No, as many as 50% of patients with genital herpes are shedding the virus without experiencing any of the symptoms. Many cases are transmitted during this time.

Signs and Symptoms

First episode, initial infection: this presents with flu-like symptoms, clusters of lesions on the genitalia that can ulcerate and spread. It may take 2-3 weeks before the lesions scab over and heal.

After the initial infection, the virus settles in the nerve root ganglia — heads of nerves that run parallel to the spinal cord — and remains dormant until stress or other factors reactivate it.

Recurrent infections begin in about 50% of patients with a “prodrome” pre-reactivation flu-like symptoms and tingling around the area where the lesions will be.

Treatment

There is no cure for herpes, however, there are a few drugs that will help shorten the duration of the symptoms and relieve the discomfort associated with herpes. These are antiviral drugs and they are available by prescription only. Therefore, see your doctor for appropriate diagnosis and treatment.

Acyclovir
(Zovirax®)
Once acyclovir enters the body, it is modified to look exactly like a natural nucleotide (nucleotides make up RNA and DNA). It then competes with the natural nucleotides to make the viral RNA. When acyclovir is incorporated into the viral RNA instead of the natural nucleotide, replication of the virus is stopped. Some of the common side effects encountered with acyclovir include headache, nausea, vomiting, dizziness, and loss of appetite.

Valacyclovir
(Valtrex®)
Valacyclovir is converted to acyclovir in the body. It therefore acts exactly the same way and has the same side effect profile as acyclovir.

Penciclovir
(Denavir®)
Penciclovir, like acyclovir, is modified once it enters the body to look exactly like a natural nucleotide. It then competes with the real nucleotides and when it is used instead of the normal nucleotides, it stops replication of the viral RNA. It is available only as a cream and is used to treat herpes sores on the face and lips. Common side effects include dulled sensitivity to touch, altered taste sensation, skin irritation or itching, and skin rash.

Famciclovir
(Famvir®)
Famciclovir is a nearly identical to Penciclovir except that it has to be altered in the body to Penciclovir first. It is the oral form of Penciclovir and comes as tablets. With the exception of the fact that is an oral drug, it otherwise acts exactly like Penciclovir. Common side effects include diarrhea, dizziness, headache, tiredness, and nausea.

Sexually Transmitted Diseases (STDs)

Some 56 million Americans have an STD other than AIDS and many more are infected each year. The causative bacterial, viral, or parasitic agents are spread primarily by sexual contact, but may also be spread by the use of infected needles. Some STDs are chronic infections, but many can be cured. Quick diagnosis and treatment are often the keys to cure.

The only 100% prevention is abstinence. Maintaining faithful monogamous relations with one’s spouse is effective, provided both partners are free of STDs. Safe sex (use of a condom) with a monogamous partner is the next best protection against STDs. Always remember that prevention is better than therapy.

Bacterial:

Gonorrhea
Gonorrhea (“clap”), a common disease worldwide, is caused by the bacteria Neisseria gonorrhoeae. There are over 650,000 new cases in the U.S. each year. 82% of cases of gonorrhea occur in teenagers and young adults, and females are twice as likely to become infected after one act of intercourse with an infected male as males are after one act of intercourse with an infected female.

Symptoms occur within a few days of exposure and include urethral or vaginal discharge and frequent and painful urination. Bacterial culture confirms diagnosis. Gonorrhea requires antibiotic to resolve, so see your doctor for appropriate diagnosis and treatment. Penicillin used to be the drug of choice but many strains have become resistant. Sexual partners should be treated and intercourse avoided until the infection is cured. Untreated gonorrhea can damage the heart or cause a form of arthritis.

Chlamydia
Chlamydia is caused by the bacteria Chlamydia trachomatis. Infection with chlamydia is often concurrent with gonorrheal infections. Chlamydia is the most frequently reported and fastest spreading STD in the United States. More than 3 million men and women in the U.S. are diagnosed each year.

Males typically experience painful and frequent urination and a urethral discharge 7-21 days after exposure. Females often do not have any symptoms and the infection is discovered in conjunction with a gonorrheal infection. Chlamydia requires antibiotics to resolve. A physician should be consulted for appropriate diagnosis and treatment. Sexual partners should be treated and intercourse avoided until the infection is cured.

Pelvic inflammatory disease
Pelvic inflammatory disease is a complication of gonorrhea or chlamydia. It is an infection that generally involves the uterus, fallopian tubes, or pelvic area. Symptoms vary but usually include abdominal pain and tenderness, fever and vaginal discharge.

This is a very serious infection and requires antibiotics to treat and may also require hospitalization. A doctor should be consulted for appropriate diagnosis and treatment. If untreated or inadequately treated, it may result in infertility and/or sterility.

Syphilis

There are more than 70,000 new cases of syphilis each year in the U.S. caused by the spirochete bacteria Treponema pallidum. The risk of infection with syphilis after a single exposure is ~50%. Syphilis has four clinical stages — primary, secondary, tertiary and congenital (passed from mother to baby). The primary stage occurs between 10 and 90 days after infection and causes an ulcer at the site of infection. The primary stage is highly infectious. Secondary syphilis occurs about 6 weeks after the primary stage and causes a rash all over the body, fever headache, loss of appetite and joint pain. The tertiary form of syphilis has many different forms and may present without any external signs or symptoms. If untreated, the third stage, can affect the heart, brain or other vital organs.

Syphilis is usually diagnosed by a blood test, The disease can cause many problems in all areas of the body including the heart, brain, skin, bone, upper respiratory tract and liver. Syphilis requires antibiotics to resolve. Consult a doctor for appropriate diagnosis and treatment.

Bacterial vaginosis
This is a vaginal bacterial infection caused by several bacteria that are normally harmless. Signs and symptoms include malodorous vaginal discharge, but you may or may not be symptomatic. This infection requires antibiotics to treat. Consult a doctor for appropriate diagnosis and treatment.

Protozoal:

Trichomoniasis
Trichomoniasis is a readily curable infection caused by the protozoa Trichomonas vaginalis. Common signs and symptoms include a mild to severe malodorous vaginal discharge, intense itching and painful urination; males may not have any symptoms.

Trichomoniasis requires antibiotic therapy, so see your doctor for appropriate diagnosis and treatment. The drug of choice is metronidazole (Flagyl®). It is very effective but may produce several side effects. Both partners should be treated.

Viral:

Genital Herpes
Genital Herpes Information

Human Papilloma Virus (HPV)

Some 5.5 million new cases of HPV infection are reported each year in the U.S.. Twenty million Americans, men and women alike, are infected with this virus. HPV is a double stranded DNA virus that is the causative agent of genital warts. There are more than 65 types of the virus. Infection with specific types of HPV can lead to neoplastic changes in genital epithelia. The lesions are usually papules or plaques that may be hard to see. In women, the infection may be intravaginal or cervical. If the cervix becomes affected, cervical cancer can result. Because of the contagious and possibly neoplastic nature of the infection, treatment is necessary.

Destructive treatment includes removal of the warts by the use of lasers, freezing or burning. Some medications may be applied by a physician (podophyllin, trichloracetic acid) or the patient with proper training (podofilox, imiquimod), but there are some side effects. These include pain, burning, inflammation, skin erosion, scarring, erythema and the medications should not be used during pregnancy. There is no cure and the warts may recur at any time. Patients with genital warts are also at risk for other STDs.

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
HIV is the virus that causes AIDS. Some 900,000 Americans are estimated to be infected with HIV with 45,000 being added each year. The most common risk factor for this disease is homosexual relations (male-to-male). In addition, the virus can be spread by heterosexual relations or by blood transfusions, although these are less common. Thus HIV infections are preventable.

HIV is a virus that affects the human immune system, specifically T-helper cells that have a CD4+ marker on their surface. These T-helper cells normally function to protect against infection.

When HIV enters one of these cells, it is protected by a capsule. This capsule breaks open and a single strand of RNA is released along with an enzyme called reverse transcriptase. Reverse transcriptase than converts the single strand of RNA into a double strand of DNA. This DNA is then incorporated into the normal cellular DNA. The rest of the immune system does not respond because the virus is inside the cell. The HIV virus has taken over the cellular machinery and forcing the immune system to make millions of copies of the HIV virus. Infected persons frequently succumb to opportunistic infections.

Clinically, HIV presents with flu-like symptoms, and then the symptoms go into dormancy but the virus continues to replicate. As the amount of HIV virus in the body increases, the immune system is further impaired and opportunistic infections become more common. Some of the most common infections include thrush (fungal infection), Kaposi’s Sarcoma (cancer), pneumonia, recurrent herpes infections, and in later stages severe bacterial, protozoal or fungal blood stream infections.

There are many medications available to help slow the progression of HIV, however no cure is currently known. If you have questions and also for appropriate diagnosis and treatment, talk to a doctor.

Women and Sleep

Some form of sleep disturbance will affect the majority of us at some point in our lives. In most cases we’ll get over it, but for some people ongoing sleep problems persist. In this fact sheet we outline some of the common causes of poor sleep and offer some simple tips to help improve sleep.

About insomnia

Insomnia is the name given to the inability to go to sleep or to stay asleep. There are several types of insomnia. It’s more common in older people who, fortunately, need less sleep.

Primary insomnia

Most adults need about seven and a half to eight hours sleep each night; however some people simply need less sleep. About two per cent of the population needs less than five hours a night. They can be highly productive and quite happy. These are not the people who visit a sleep disorder clinic; however not everyone in this group wants to live this way. Many would rather go to bed at the same time as their partner or simply don’t want to lie there until 1.30am. These are the people who seek help and who may say, “Oh, I’ve never been a good sleeper”. But they still manage to function well and are generally not tired.

It’s interesting to note that other family members will often have the same complaints. They’re tricky to treat as they are very resistant to non-drug strategies. Basically, it is recommended they go to bed for fewer hours – while listening to their own body clock for clues. Some simple lifestyle changes may also have an impact. See tips to improve your sleep.

Insomnia stimulated by an incident

Have you always been a good sleeper but something has triggered a change in your sleep patterns? Often the trigger is a period of emotional trauma; perhaps your shifts at work have altered or you’ve had a baby. Bad habits persist beyond the trigger period because your body has now learned that this is the norm. Patients visit sleep clinics feeling frustrated and anxious. This emotional state only makes the problem worse.

With this group a range of psychological techniques aimed at ‘unlearning’ the conditioned sleep pattern may be suggested. Sleep clinics offer strategies to overcome anxiety or frustration and will also recommend changing lifestyle habits. See tips to improve your sleep.

Disorders of the body clock

These people cannot be described as having insomnia, but instead, have problems with their timing rather than quality or duration of sleep. Usually people with disorders of the body clock have trouble getting to sleep and are then unable to get up in the morning. This can pose a real problem for those of us who have to get up early to go to work. When the body clock is unhappy, the person carrying it around is bound to feel sleepy during the day and will crave recovery sleep on the weekend.
The body clock can be manipulated with carefully timed exposure to bright light. In the same way that our body clocks adjust to differing time zones when traveling, we can shift body clocks with light exposure, best managed with a sleep specialist or sleep psychologist.

Some other causes of sleep disturbance

Menopause

Menopause symptoms, particularly hot flushes and night sweats, can disturb sleep.

Sleep apnoea

Sleep apnoea is when the airways are blocked, causing airflow and breathing to stop for a short time during sleep.

Depression and anxiety

Depression and anxiety can affect sleep, or be caused by lack of sleep. Counseling may be helpful.

Shift work

Working when your body thinks you should be sleeping can impair sleep and lead to chronic sleep disturbance.

Pain

Pre-existing and chronic conditions can impair sleep. Addressing the pain may be helpful.

Tips to improve your sleep

Ask yourself whether you need to change a few of your habits to get a good night’s sleep.  Sometimes a change in routine is all it takes.

Caffeine

Cut your caffeine intake to two a day – including cola, as well as tea and coffee.

Alcohol

Too much alcohol reduces sleep quality. Limit yourself to two standard drinks a day.

Exercise

Here’s a secret tip: your body temperature will drop nicely, which is necessary for a good sleep, if you do some rigorous exercise four to six hours before going to bed.

Regular timing of bed and wake times

This is important for those with body clock disorders. Important: try to get out of bed at the same time each day.

Total time in bed

Restrict the amount of time you spend in bed in an attempt to train yourself to sleep when you get there. Restrict bed time for sex and sleep – not eating, reading or watching TV

If not sleeping, get out of bed

Frustration at your inability to sleep makes the problem worse. Regain control. Get out of bed and do a quiet, relaxing task in another room.

Hide the clock

Do not clock gaze during the night. This accentuates the sense of frustration. Turn you clock away from view.

Relaxation techniques

Mediation and relaxation may help some people to relax and get to sleep.

Medications for sleep disturbance

Sleep medications (e.g. benzodiazepines, stilnox) may be prescribed for short-term use; however these medications may cause dependence and should be taken with care.

Uterine Fibroids

What are fibroids?

Fibroids (also know as uterine fibromyomas, leiomyomas or myomas) are non-cancerous growths or lumps of muscle tissue that form within the walls of the uterus (womb).

Fibroids can vary in size ranging from the size of a pea to the size of a rockmelon.

What causes fibroids?

It is not known exactly why fibroids occur; however we do know that the female hormones, oestrogen and progesterone, play a significant role in stimulating the growth of fibroids. Fibroids occur in women of reproductive age, growing at varying rates until the onset of menopause, when they tend to decrease in size and may slowly disappear due to the loss of oestrogen and progesterone.

Symptoms

Fibroids occur in about 50 per cent of women. Many women will go through life not even knowing that they have fibroids as they do not commonly cause symptoms; however for some women they may affect the menstrual cycle or period, fertility, or be the cause of miscarriage or premature labour.

For these women, symptoms may include:

  • Heavy or prolonged periods
  • Iron deficiency (anaemia)
  • Frequent urination
  • Pressure sensation on the bladder, bowel or back
  • Lower back pain
  • A lump or swelling in the abdomen
  • Period pain
  • Painful sex
  • Infertility
  • Miscarriage or premature labour

Fertility is not a common problem in women with fibroids, probably affecting less than three per cent of women. In very rare instances, fibroids may become cancerous.

Diagnosis

Fibroids are usually found during a gynaecological exam, ultrasound, hysteroscopy, laparoscopy, or during surgical procedures for other conditions. A hysteroscopy is an internal examination, usually under a general anaesthesia, performed using a hysteroscope (like a telescope), which is inserted into a woman’s uterus to assess the inside cavity. A laparoscopy is an examination, performed under a general anaesthesia, through an incision in the navel (umbilicus) to look at or operate on the pelvic organs, i.e. uterus, ovaries and uterine (Fallopian) tubes.

Treatment

Most fibroids will not require treatment unless they are causing problems (e.g. impairing fertility or causing period pain, heavy bleeding or pressure symptoms).

The treatment will depend on:

  • The symptoms caused by the fibroid(s) and the degree of impact on quality of life
  • The position of the fibroid(s)
  • The size of the fibroid(s)

There are a variety of treatments for fibroids depending on their size and impact.

Treatments may include:

  • Hormonal therapies – GnRH angonists are used to shrink fibroids, particularly when interfering with fertility
  • Endometrial resection
  • Myomectomy
    • Laparoscopy
    • Laparotomy
  • Uterine artery embolisation
  • Hysterectomy

The only procedure that will permanently prevent fibroids from growing or recurring is a hysterectomy (removal of the uterus).

Hormonal therapies

GnRH agonists, which cause a temporary menopause, are prescribed to shrink fibroids in the short-term, particularly when they are interfering with fertility.

Endometrial resection

Endometrial resection is an operation under general anaesthesia using the hysteroscope to excise (cut out) a submucosal fibroid (fibroids that are partially or completely in the uterine cavity and partially in the wall of the uterus, usually causing heavy periods).

Myomectomy

Myomectomy is the complete removal of a fibroid either by laparoscopy or laparotomy (an open procedure through an incision in the lower abdomen). The fibroid is removed by opening the uterus over the fibroid and removing it completely. The uterus is then stitched over where the fibroid was removed from.

Uterine artery embolistation

Uterine artery embolisation is a procedure performed by an interventional radiologist under X-ray control and either sedation or anaesthesia. A catheter is inserted into the femoral artery in the groin and threaded into the uterine artery. A substance or coils are inserted to block the artery (one or both) to reduce the blood supply to the fibroid. The size of the fibroid can shrink by 30-50 per cent.

Hysterectomy

Hysterectomy is the removal of a woman’s uterus. Having a hysterectomy is major surgery. The decision to have a hysterectomy should only be made after the woman has been given adequate information about why, how and what the consequences may be. It is important that each woman thinks about how she feels about losing her uterus.

In a woman with fibroids, the size of the fibroids will indicate which form of hysterectomy is appropriate. An abdominal or open hysterectomy is the correct way in women with a very large fibroid uterus which is easily felt in the abdomen. If the uterus is smaller, a laparoscopic hysterectomy or vaginal hysterectomy may be the preferred technique.

Uterine fibroids will not recur if the whole of the uterus is removed (total hysterectomy). A total hysterectomy means that the whole of the uterus including the body of the uterus and the cervix are removed. A total hysterectomy does not routinely include the removal of the ovaries.

For more information see Hysterectomy

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Heavy Uterine Bleeding

What is heavy uterine bleeding?

Heavy uterine bleeding (also known as menorrhagia) is a common problem in the 30-50 year age group.

For about 50 per cent of women with heavy bleeding the cause is unknown (dysfunctional uterine bleeding). For the other 50 per cent the cause may be related to:

  • Endometrial  polyps  (thickening of the endometrium, usually benign, looks like a large ‘tear drop’ of tissue)
  • Endometrial hyperplasia (generalised thickening of the endometrium which can progress to being cancerous)
  • Endometrial cancer (cancer of the uterus)
  • Fibroids (benign tumours or lumps originating from the muscle of the uterus)
  • Adenomyosis (endometrial cells growing in small pockets inside the muscle layer of the uterus causing pain and bleeding)
  • Intra uterine device (a contraceptive device also known as an IUD), usually of the non-hormone releasing type

NOTE: The endometrium is the lining of the uterus

If, after tests are performed and no cause for the heavy bleeding is found, your health practitioner might tell you that you have dysfunctional uterine bleeding.

How do I know if my bleeding is too heavy?

It is very difficult to work this out, but if your bleeding is becoming heavier than usual, interfering with your daily living, or worrying you, then seek help.

What signs should I look for?

  • Unusual increase in blood loss
  • More than seven days of bleeding
  • Bleeding or flooding not contained within pads or tampons (especially if wearing the largest size)
  • Clots greater than a 50 cent piece in size
  • Dizziness, fatigue or looking pale during your period
  • Waking up at night several times to change pads/tampons

How may it affect me?

  • You may feel fatigued or dizzy, or look pale
  • You may be low on iron because of the blood loss
  • You may become very self-conscious of the heavy bleeding and fear the bleeding will come through your clothes – especially when you are in public
  • You may prefer to stay at home because of having to change pads or tampons frequently

Other possible causes

  • Underactive thyroid gland (hypothyroidism)
  • Bleeding disorders where excessive bleeding can occur e.g. Von Willebrand disease, but is more common in teenagers
  • Chronic kidney disease

What therapies are available?

  • Your health practitioner may recommend iron therapy. This is usually a tablet that is taken daily
  • Your health practitioner may prescribe other medications such as:
    • Certain anti-inflammatory drugs to reduce bleeding and period pain
    • Tranexamic acid to reduce the bleeding
    • An IUD, releasing a hormone which thins the endometrium and reduces bleeding up to 95 per cent after 12 months of use
    • The contraceptive pill to reduce period pain and provide contraception (blood flow can be reduced by up to 50 per cent by using the pill)
    • Progestogens (synthetic forms of progesterone, one of our female hormones) to reduce blood loss by about 30 per cent
  • Surgery is offered if medicines have failed to solve the problem. Surgery is recommended if:
    • Medicines fails to reduce bleeding
    • There are other symptoms, such as pain
    • You discuss the option with your health practitioner and you both feel it is the most appropriate option. Your health practitioner may describe and offer endometrial ablation or hysterectomy.

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