World Health Day on the 7th April 2022

On the 7th April 2022, we celebrate ‘World Health Day’. This year’s World Health Day theme is ‘Our Planet, Our Health‘ which aims to direct global attention towards the well-being of our planet and the humans living in it.

At Hormone Health, we are focused on the health and wellbeing of our patients. Our strapline is: Good Hormones. Good Health. Good Life. In order to achieve this not only do we need to ensure that we as individuals remain healthy, but also the planet we live in.

We’ve been living in pandemic, a polluted planet and have seen an increase in diseases such as cancer, asthma and heart disease. We need to keep the people healthy. We need to keep the planet healthy and move to creating societies focused on well-being.

An estimated 13 million deaths around the world each year (stats from WHO) are due to avoidable environmental causes. These include the climate crisis which is the single biggest health threat facing humanity. It’s time to make a change.

Hydration – how much should we drink?

Good hydration is essential to ensure that all bodily functions are able to take place as normal. How much should we drink, what kind of drinks should we choose and what are the signs of dehydration?

Why do you need fluids?

Water in the body is essential for so many important processes to take place. From your blood system carrying essential glucose, oxygen and nutrients to cells, to the kidneys getting rid of waste products you no longer want. It also lubricates your joints and eyes, helps your digestive system function and keeps your skin healthy.

You are uniquely designed to regulate our own body temperature, particularly in hot conditions, by losing more water through the skin (perspiration), which in turn acts to cool the body helping to maintain a stable temperature. The more water you lose through sweat, the more you need to replace, so when the weather’s good, or you lose more fluid than normal doing sport the more you’ll need to drink.

Why do you need to keep hydrated?

Fluid is so important in the body that even when levels drop only slightly, you begin to feel the consequences. Low levels of fluid in the body can cause headaches, feelings of dizziness, lethargy, poor concentration and a dry mouth. Over a longer term, dehydration can cause constipation and can increase urinary tract infections and the formation of kidney stones.

How much do I need?

Adults need to drink around 1.5–2 litres of fluid a day. A typical mug or glass is about 200 millilitres (ml) so this equates to 8-10 drinks a day. Don’t forget that fluid needs can vary depending on various factors including level of physical activity and climate, so it is best to remember to drink regularly to keep thirst at bay. Remember to take a bottle of water with you when you go for a walk, to the gym, for a run or game of football or rounders and drink a little every now and then!

How do I know I’m drinking enough?

Simply waiting for the sensation of thirst is not a good enough sign of a need to drink – by the time you feel thirsty your body is already dehydrated and potentially suffering some of the effects. Equally, simply drinking to eliminate the feeling of thirst does not fully hydrate the body.

The best indicator of good hydration is urine colour, a pale straw coloured urine being a reliable indicator of good hydration. Darker coloured urine is a sure sign that the body needs more fluid. Getting into the habit of drinking regularly is a great way of keeping hydrated.

What drinks count?

Any drink will help to promote hydration. Water from the tap is a great choice, not least because it’s readily available and free. Other drinks count towards our total fluid intake too; milk, fruit juice, tea, coffee and soft drinks are all over 85% water and can be included in total fluid intake.

Some drinks contain other nutrients in addition to fluid such as sugars, fats, vitamins and minerals. Fruit juice is one such drink with vitamins, minerals and sugars too. A glass does contribute to fluid intakes and also provides one of the recommended five portions of fruit and vegetables. Don’t forget that the recommended portion is 150ml though, and only one glass of fruit juice counts each day.

Drinks with added cream and/or full fat milk provide more calories and higher fat intakes are not generally recommended within healthy eating guidelines, so drinks like creamy hot chocolates are best considered to be treats!

There has been confusion about coffee in particular, with some wrongly thinking it does not hydrate the body as it contains caffeine. Although caffeine is a mild diuretic, the fluid provided by a cup of coffee or tea far outweighs the mild dehydrating effect of caffeine and the fluid levels in the body are improved.

Most of the fluid we consume comes from drinks, but around 20–30% comes from foods. Fruit and vegetables such as courgettes, cucumber, tomatoes and melon are over 90% water and make a valuable contribution to our overall fluid intake.

Don’t forget

Good hydration is critical to health and keeps our bodies performing at their best, not only in terms of all the processes that go on but also keeping our levels of concentration up. The best advice is to keep a bottle of water close by to top up fluid levels regularly and keep thirst away.

Nigel Denby, BSc Hons, RD Registered Dietitian

@menopause_dietitian
Founder of www.harleystathome.com

Endometriosis Awareness Month

Endometriosis is an inflammatory condition where endometrial tissue (tissue similar to the lining of the uterus) grows outside of the uterus.

Woman with endometriosis can experience a range of symptoms including:

  • Pain, especially excess menstrual cramps that affect the belly and lower back
  • Pain during and after intercourse
  • Abnormal or heavy bleeding
  • Infertility
  • Painful urination during the menstrual period
  • Panful bowel movements

There are a range of tests that can be completed to check whether you have endometriosis including:

  • A pelvic exam
  • Ultrasound
  • MRI
  • Laparoscopy

For some women, endometriosis can affect day to day life and can sometimes lead to depression. It’s also known as a silent condition. It’s important for anyone experiencing these symptoms to get checked out and this is where Hormone Health can assist.

Nicola, an endometriosis sufferer said:

As a teenager I always suffered with heavy bleeding and lots of pain. My cycles were regular but I knew they were not right compared to what my friends experienced. I often had to have days off school because I literally could not stand nor get out of bed.  My GP kept saying it was normal, and despite trying a range of contraceptive pills to help, nothing did. Eventually, after a number of years, I was offered an ultrasound. Nothing showed up on the ultrasound but breaking down to my doctor, they referred me to the local hospital for a laparoscopy. It was then that they found cysts the size of golf balls on both of my ovaries as well as a huge amount of endometriosis which was all lasered off”.

She continued: “I was told the chances of having children were slim following my diagnosis but luckily, I recovered and have had two beautiful children – naturally. As I have aged, the endometriosis has returned, and I have since had further surgery. It’s not a nice disease. It’s hidden, it’s painful and you can feel very lonely and isolated but I am so pleased to see companies like Hormone Health now around supporting patients with this horrible disease”.

Our team of associates are highly experienced across women’s health. In addition to specialising in menopause, peri-menopause and HRT, we can also assist with endometriosis diagnosis.

We have a talent team of associates onboard, including Ed Coats who is a a Consultant Gynaecologist and Specialist in Reproductive Medicine and Surgery. Mr Coats is an experienced hysteroscopic and laparoscopic surgeon and is based within our London team where patients can book either face to face or virtual consultations.

Mr Coats says:

“Endometriosis can be such a debilitating disease for so many women, and significantly affect their quality of life. Patients often come to see me having tolerated years of pain. Using the right diagnostic tools and the right strategy we can help turn this around”.

Find out more about Mr Coats here.

 

 

Contraception for the over 40’s

As women get older their contraceptive needs change  for many different reasons. this is at a time  when their natural fertility is declining as they approach menopause but contraception is still  important should they not wish an unplanned pregnancy, 10-12% of women between 40 and 49, not using any method of contraception can expect to become pregnant.

When women enter their forties,  they may begin to experience symptoms of menopause, as well as developing other health issues in addition to changes taking place in their  personal lives,  all of this can impact on their contraceptive choice.

As women get older they have an increased risk of obesity, cardiovascular disease and breast and gynaecological cancers.

No method of contraception is contraindicated by age alone, until 50 when women are advised against oestrogen containing methods.

In this article i will talk through the various options, the risk of failure and an unwanted pregnancy and pregnancy itself should always be set against the risk of the method used.

Non-Hormonal methods

There are 3 types, barrier methods, natural family planning and withdrawal.

Barrier methods

These literally provide a barrier between the sperm and the egg preventing fertilisation. there is no age barrier and minimal contraindications

They include, male and female condoms, diaphragms and cervical caps , and  are usually more effective in older women due to better compliance , coupled with a decline in fertility.

The main disadvantage is that they are highly dependant on the user, and may not be suitable for women suffering with any type of genital prolapse, more common in older women,  or if their  partners suffer with erectile dysfunction, diaphragms and cervical caps need to be fitted initially by a properly trained clinician.

Condom use, either alone or in conjunction with other methods should also be advised for women who at high risk of STIs.

Natural Family Planning

This becomes less reliable as women age , periods often become unpredictable and “safe time” cannot easily be calculated , cycles may become anovulatory and the cervical secretions are more difficult to interpret

Withdrawal

This is not promoted but never less is still used by by about 5% of women, it has a high failure rate , approximately 20%.

Hormonal Methods

Hormonal methods are contraceptives which contain either an oestrogen and a progestogen, progestogen alone.  They  can be administered in a number of different guises, depending on the type used.

Combined methods, containing both oestrogen and progestogens, are commonly given as a pill but are also available in the form of patches and vaginal rings. They are given cyclically and induce a monthly bleed, in some circumstances patients may be advised to use them continually and then no withdrawal bleed occurs. In women over 40, they  should only be prescribed after consulting the UKMEC categories and ideally be a brand that contains levonorgestrel or or norethisterone, rather than other progestogens.

Progesterone only contraception can be in the form of pills, taken daily without a break , injections, every three months, implants inserted into the upper arm, which lasts for 3yrs and finally progesterone containing intrauterine devices .

Progesterone only pills are soon to be available via pharmacists in much the same way as the after sex pill and negate the need to see a doctor or a nurse.

Menstrual bleeding problems increase with age and women should be encouraged to seek advice for their doctor if there is any change in their usual bleeding pattern

How different hormonal methods of contraception may affect the menopause

In women using contraception containing oestrogen , the symptoms of the menopause are often, masked and blood measurements of both estradiol and follicle stimulating hormone, the main marker for menopause, are suppressed and so cannot be used to base advice about stopping contraception or menopausal status.

In women using progesterone only methods , then FSH can be used to diagnose menopause but generally speaking blood tests are not required to diagnose the menopause over the age of 45.

The diagnosis of menopause is made on the basis of menstrual change and the development of menopausal symptoms. Menopausal symptoms are not masked in the same way using progesterone only methods, and hormone replacement therapy can be added into the progesterone contraceptive.

If a women is using a  Mirena levonorgestrel IUS ,she is likely to be amenorrhoeic and this could also confer endometrial protection as well as ongoing contraception. Hormone replacement therapy alone is not a method of contraception.

The IUS only has a license to confer endometrial protection for five and so the women should be advised either a change of device or be prescribed HRT containing both oestrogen and progesterone, thus providing contraception until 55. The progesterone only pill , implant and injectable are not recommended for endometrial protection as part of HRT

If the women is using progesterone only method then hormone replacement therapy can simply be added in sequential form, either as a patch of a gel.

It is important to remember that younger women can become menopausal, 1% of women under the age of 40 and 5% under the age of 45, will develop premature ovarian insufficiency,(POI) and if these women continue taking the pill unknowingly there is clearly the possibility they have had the menopause and it has gone unnoticed and,  5% under the age of 45 and whilst this is not diagnosed as POI, the diagnosis may be missed depending on their chosen method on contraception.

When to stop using contraception?

Generally all women can stop contraception over 55yrs of age, as spontaneous conception is very rare even in the presence of regular bleeds.

For women under 55yrs of age, the simple answer is when the menopause is reached but it may be masked by hormones and is only a retrospective diagnosis , made by amenorrhea lasting12m after the last period.

If taking progesterone only contraception and the patient is period free and keen to stop using contraception , it may be helpful to measure the FSH level and if raised , advised further use for 12m before discontinuing their pills.

Article written by Dr Joanne Hobson

Beat bloating….forever! Tip you’ve never heard of before

Think bloating, swollen “football” tummy, pain, gas and even worse, sudden and unpredictable changes in your bowel habit! These are all symptoms associated with Irritable Bowel Syndrome (IBS), the umbrella term widely used to describe digestive problems. Not all bloating is due to IBS. If you suffer from time to time but don’t think you have IBS it’s worth trying a low FODMAP diet for 2-3 weeks. If things improve, keep going for the full 8 weeks.

IBS is notoriously difficult to treat and a lot of people suffer in silence for years. FODMAPs are a real breakthrough, giving up to 70% of sufferers real, lasting relief and control over their symptoms. Unlike most IBS “miracle cures” FODMAPs are based on science. The approach has been developed in clinical trials and hospitals across the globe and its gathering support of doctors, gastroenterologists and dietitians.

How does it work?

The idea is simple – you need to remove FODMAPSs from your diet as completely as possible for about 8 weeks. This gives your digestive system and chance to rest and recover.

Then you gradually reintroduce FODMAPs to see if they still cause you problems. Some people can include all the FODMAP again with no further problems, other have to continue to avoid some of the FODMAPs but very few people need to avoid them all permanently.

Word of warning! This is not a weight loss diet!

It’s a diet to help your digestive system. You shouldn’t follow the eating plan for more than 8 weeks and if you are concerned about following the diet for any reason consult your GP.

The low FODMAP Plan

We don’t promise this is an easy plan to follow, the best way to stick to a low FODMAP eating plan is to prepare as much of your food as possible from scratch and eat out as little as possible.

The only good news we can promise is that it is only for 8 weeks and if you have been suffering there’s a really good chance this will help- so it has to be worth a try, right?

The first thing you need to know is what foods contain FODMAPs – these are all the foods you need to try to avoid for the next 8 weeks.

High FODMAP foods: AVOID

  • All foods containing wheat, rye – e.g. bread, flour, pasta, some cereals, biscuits, cakes and pastries
  • Foods containing high levels of lactose (milk / sugar) – e.g. cow’s, sheep’s and goat’s milk, processed cheese, cottage cheese, any low fats cheese and ricotta cheese, most yoghurts, ice creams and custards
  • Pulses – all peas, beans and lentils
  • Foods containing artificial sweeteners called polyols – sugar free mints, chewing gum, and sugar free sweets and sugar free chocolate
  • Most (but not all) fruits which have pips or stones – apples, pears, apricots, peaches, plums and nectarines. You need to avoid blackberries, cherries, grapefruit, pomegranate and lychees too
  • As well as pulses, you need to avoid these vegetables – asparagus, avocado, beetroot, celery, garlic, onion, leeks and mushrooms. You’ll also need to leave out brassicas like broccoli, cauliflower, sprouts and green cabbage. And, there’s no sweet potato, squash and sweetcorn either.
  • Lastly – no dried coconut, pistachios, cashew nuts or honey
So, what can I eat?
  • Get friendly with the Free from isle in your supermarket – there’s plenty of choice for wheat free breads, pizza bases, pasta, biscuits, cakes, crackers and cereals. As long as they are wheat free you can go ahead. Some spelt bread is also wheat free so check these out at health stores
  • You’ll also find plenty of Soya alternatives to dairy foods – milks, yoghurts and custards are especially good. Go for Soya if possible as these have added calcium so you don’t miss out
  • Hard cheeses like cheddar or parmesan are fine – you can also have feta, mozzarella, brie, camembert and goat’s cheese. Butter is okay too
  • There are also lactose free dairy products around and these are all okay too. And, yes you can have chocolate but stick to dark chocolate
  • There’s no other way to guide you around fruits and veggies other than to list them. It’s really helpful to keep the list of okay fruit and veggies with you when you’re shopping
Fruits

Banana, blueberry, cantaloupe melon, clementine, cranberries, grapes, honeydew, kiwi, lemon, lime, orange, papaya, passion fruit, raspberry, rhubarb and strawberry

Veggies

Aubergine, bamboo shoots, beansprouts, cabbage (white) ,carrot, chard, chilli, courgette, chives, cucumber, endive, ginger, lettuce, olives, pak choy, parsnip, peppers, potato, radish, rocket, seaweed, spinach, spring onion (green only), swede, tomato and turnip

Try to make sure you still have your 5 a day.

Herbs and spices

Two of the hardest ingredients to exclude are garlic and onion so you’ll be glad to know you can use all other herbs and spices to add flavour to your cooking. You may want to try Hing or Asafoetida powder (from Asian supermarkets). This is fine on a low FODMAP diet and gives a good alternative flavour to onion and garlic

Nuts and seeds

Most are fine accept pistachios and cashews

Fats and oils

All are low in FODMAPs so are okay to include

Drinks

Try and avoid caffeinated drinks like tea, coffee and cola as the stimulant effect of caffeine can irritate IBS, so can alcohol so while you are following the low FODMAP diet it’s best if you can lay off the booze

Jams and marmalades

These are fine – but avoid low sugar varieties which contain artificial sweeteners

Meat and Fish

You can eat any meat, fish or poultry providing it is not breaded. Eggs are also perfectly fine and you can have between 4 and 6 eggs per week

Low FODMAP meal ideas

Breakfasts
  • Porridge made with soya or lactose free
  • Cornflakes or rice krispies with free milk
  • Wheat free toast with butter or peanut butter
  • Boiled, scrambled or poached eggs with wheat free toast
  • Smoked salmon and scrambled eggs
  • Cheese, chive and pepper omelette
  • Grilled bacon, egg and tomato
Lunches:

Try and plan these ahead and take them with you if you are having lunch at work or on the run

  • Homemade soup with wheat free bread- make sure you leave onion out of any soup recipes
  • Baked potato with cheese, tuna, homemade chilli (no beans)
  • Wheat free crackers with cheese, cherry tomatoes, cucumber and sliced pepper
  • Mixed salad with homemade potato salad and cold meat
  • Rice salad with roasted tomatoes, peppers and courgettes and smoked mackerel
  • Quinoa salad with feta cheese, olives, tomato and cucumber and chopped fresh herbs
  • Sushi or sashimi
  • Sandwiches made with wheat free bread, rolls or pitta
Dinner
  • Fish, steak, chops or chicken with potato, salad or vegetables
  • Risotto (no onion) with salad
  • Caesar salad with grilled chicken or salmon
  • Greek salad (no onion) – lettuce, tomatoes, cucumber, olives and feta with grilled fish and baby new potatoes
  • Quinoa with roasted vegetables and harrisa spiced lamb chops (rub harrisa spice mix into lamb chops before grilling)
  • Quinoa with roasted vegetables and baked goats cheese
  • Wheat free pasta Carbonara made with pancetta, egg and soya cream, lots of black pepper and parmesan
  • Omelette with low FODMAP filling, salad and baked potato
  • Stir free low FODMAP veggies with chicken, rice or wheat free noodles. Make a sauce with sunflower oil, chilli, ginger, lime juice and a little sugar.
Snacks
  • Soya yoghurt
  • Fruit from low FODMAPs list
  • 50g suitable nuts
  • Rice or corn crackers with pate, peanut butter or cheese
  • Wheat free biscuits
  • Wheat free cake
  • Flapjack (made simply with oats, butter and golden syrup)
  • Crisp- ready salted or salt and vinegar only

Other things to do to help take care of your digestives system

The low FODMAP diet is all about giving your digestive system a chance to rest . Relaxing your mind and body has a really positive affect on their digestion too. Try to have a weekly massage, facial or some sort of treatment which is designed to help you relax. At night before you go to sleep, gently massage you tummy from right to left in a circular motion, do this for 5-10 minutes before you go to sleep. It’s unlikely that you’ll be able to avoid stress completely during the low FODMAP phase but try and follow the diet when you think life is going to be relatively calm and relaxed.

Reintroducing FODMAPS

Hopefully you will have noticed a dramatic improvement in your symptoms since you’ve been following the low FODMAP plan. After all the hard work’s over the end is in sight! It’s time to start the reintroduction phase.

There is a set way to do this- You need to introduce a high FODMAP food over three days. If after three days you are symptom free that food can be included in your diet and you can assume it does do not cause you a problem.

If your symptoms return within the three days, you should assume the food does irritate your symptoms and it will need to be avoided long term.

How to introduce a challenge food
  1. Continue with your low FODMAP plan
  2. Food high in fructose or lactose can be introduced in groups. You can assume if one food from the fructose group doesn’t cause a problem, all foods from the same group will be okay. The same goes from the lactose group
  3. Introduce the trial food in isolation e.g. 1 teaspoon of honey – not a honey coated cereal- the cereal will contain a lot of ingredients other than honey and may give you a false result
  4. Fructose group challenge: Honey-try 1 teaspoon of honey on three consecutive days- don’t introduce any other new foods. If after day three you are symptom free you can go on to include any of the following foods: Asparagus, mango, sugar snap peas, apples, pears, peaches and watermelon
  5. Lactose group challenge: Milk: try 100 ml of cow’s, sheep’s or goat’s milk. If after day three you are symptom free you can go ahead and introduce all dairy foods- cheeses, yoghurts, custards etc

The remaining FODMAP foods need to be reintroduced one at a time using the same three day test. Follow this order of foods if you can.

Order of reintroduction: try for 3 days in isolation

Wheat (shredded wheat), onion, garlic, leek, apricot, artichoke, avocado, beans (try butter beans canned in unsalted water- if okay all beans will be okay), beetroot, blackberry, broccoli, Brussels sprout, cabbage, cashews, cauliflower, celery, cherry, fennel, grapefruit, lentils, mushrooms, peas, peaches, pistachio nuts, pomegranate, squash (butternut), sugar free mints or gum, sweetcorn, sweet potato.

If you get symptoms after a food challenge avoid that food completely. You can re-challenge again at a later date if you want to try again. If you know there are days when you have to eat out or when it’s going to be difficult to control your diet take a break from reintroducing and start again when you have a better routine

What about the long term?

Everybody has a tolerance level to FODMAPs. If you eat too many high FODMAP foods in a short space of time you may get symptoms so it’s will be good to be wary of over doing it. The main aim of the low FODMAP diet trial is to give you control over your symptoms. If you make a mistake you will not do your digestive system any harm, it’s just a mistake – now you’ll probably be able to work out what caused the symptoms.

If you are worried that your long term diet is not providing all the nutrients you need, let us know and we can point you in the right direction.

Menopause Myths

Menopause myths. We separate truth from fiction.

Written by Hormone Health Associate
Dr Justine Setchell Consultant in women’s health and the menopause.

It is heartening to see so much information out there about the menopause these days, and to see taboos and barriers being broken down. But it is still frightening how many untruths persist. As a GP with a long-standing interest in Menopause as well as women’s wellness, I would like to set the record straight. I am in the privileged position of working as a GP in a private menopause clinic, but I am very much aware that this service is only accessible to a small minority of women. It is important that evidence-based, sensible menopause advice is available to everybody.

So, let us look at some of the most common myths around Menopause:

Myth 1: Menopause is something that happens in your late forties/early fifties.

The average age of the Menopause is indeed 51, but an early menopause is defined as starting between the ages of 40-45. Women under the age of 40 and going through symptoms of menopause, are known to be experiencing premature menopause.

It breaks my heart the number of times I have seen younger patients, who have been backwards and forwards to rheumatologists (aching joints) cardiologists (palpitations) urologists (recurrent urinary tract infections) or psychiatrists (anxiety/depression) without anyone thinking to join up the dots. Taking the time to ask her about her menstrual cycle or family history of early menopause. Not all women present with classic menopause symptoms of hot flushes/sweats. I feel that premature menopause should be part of all of my specialist colleague’s differential diagnosis.

Myth 2: I’m too young for HRT/it’s too risky.

HRT in women under 51 is a very different prospect to HRT in women over 51. In younger women, they are quite literally replacing the hormones they were “entitled to” and would have had if they hadn’t experienced an early menopause transition. So, the same HRT risk profile does not always apply. Hormone replacement, as well as resolving symptoms, is essential to prevent premature bone loss, adverse cardiovascular effects and possibly early adverse effects on the brain.

Myth 3: HRT will cause weight gain.

In my experience, this is quite the opposite, as long as lifestyle factors are also addressed. I am often asked how to lose weight during menopause or keep on top of weight gain. The truth is that lower levels of oestrogen are associated with insulin resistance so I am afraid that simple/processed carbohydrates are the menopausal woman’s enemy. We just don’t metabolise carbohydrates as well which results in central weight gain (that stubborn bit in the middle!) A low carbohydrate approach along with daily activity (aim for at least 10,000 steps a day) and optimisation of hormone levels usually works well.

Myth 4: I won’t be able to keep my bladder under control

I’m glad that urinary incontinence is now talked about more openly but frustrated that it is often thought of as an inevitable part of the menopause transition. Women’s entire uro-genital area is affected by the menopausal drop in oestrogen levels so urinary symptoms are quite common but so often easy to resolve with the use of low dose topical oestrogen. Pure stress incontinence (often associated with prolapse) is a whole different ball game but before patients go down the urology investigation line for urgency symptoms or recurrent infections, it’s often worth at least trying some topical oestrogen first.

Myth 5: Testosterone will make me hairy!

Patients do sometimes experience a little additional hair growth at the site of application, so I just tell them to apply to the very low abdomen. Testosterone is often overlooked, and in some patients, replacement makes all the difference to the management of their menopause symptoms. Patients describe a “tsunami’ of tiredness where they would happily lie on the floor as their family walked over them. I find that even a small dose of testosterone in these patients can make all the difference in getting through the day. Sadly, many NHS GP’s are reluctant to prescribe but do persevere! Testosterone replacement is included in the NICE guidelines.

Menopause symptoms can wreak havoc on women’s bodies, having a real impact on day-to-day life, so women should gather as much information as possible on the help and treatments that are available to them. We could certainly write part two (or three!) to this but for now, if you would like more information or ammunition with which to approach your doctor, the following resources are invaluable:

Www.thebms.org.uk

Www.hormonehealth.co.uk

Www.daisynetwork.org

If you would like any advice, or to discuss your health needs, please contact Dr Justine Setchell at Hormone Health 92 Harley Street Clinic.

Dr Justine Setchell has been a GP for 21 years, latterly within the private sector. She trained at Imperial College Medical school. In addition to holding her Certificate in Menopause Management, she is a member of The British Menopause Society and a Diplomate of the Royal College of Obstetrics & Gynaecology.

Get in touch. We can help.

+44 (0)808 196 1901
hormonehealth@92Harleystreet.com

Would you like to see more blogs from Hormone Health? Click here

Edition 34: December News

Merry Christmas

2020 has been a difficult year for most due to the COVID 19 pandemic and our thoughts go out to all of you who were directly affected and particularly those that lost loved ones. If nothing else this has shown us the importance of maintaining good health, particularly in menopause.

It is for this reason that we at Hormone Health endeavoured to keep our services going, even through the worst of the Pandemic.

Read our Newsletter

Our December Newsletter provides a round-up of all the initiatives we have been involved with during the year so you can catch up on all our news.

Social Media & Blogs

They are a great source of up to date information with the latest news, facts and research surrounding women’s health. The Hormone Health blogs are often a good place for other information…

Facebook Twiter Our blog

Help us spread the word

If you think any of your friends or family would be interested in our newsletters, please share it with them or they can subscribe directly.

Intrauterine Device (IUD)

Your Contraception Guide

Written by Hormone Health Associate Dr Tina Peers Consultant in Contraception and Reproductive Healthcare.

Not all contraceptives have to contain hormones.

If you have a contraindication to using hormones or would simply prefer not to use synthetic hormones used in many contraceptive methods, then please do consider an intrauterine copper device. There is one condition to this recommendation. As the copper IUD makes the lining of the uterus slightly inflamed, and thus unsuitable for implantation, (its main function is to actually kill the sperm as it is a spermicide) periods can be heavier and longer. Therefore, this method is not recommended for women who have heavy or painful periods already.

How long do they last and how effective are they?

The IUD is almost as effective as the IUS, typically fewer than 1 in 100 women will get pregnant in one year.

There are different types of copper IUD and therefore depending on which one you choose; it can last for 5 to 10 years. Obviously if it doesn’t suit you it could be removed at any time. The woman is in complete control of the method. Copper IUDs are certainly very convenient for women as it is another ‘fit and forget’ method.

How does it work?

Unlike the IUS, it does not reduce or stop the periods. The woman’s cycle continues and the periods generally become slightly heavier and slightly longer than they were prior to the fitting.

Are there any contra indications to these methods?

An allergy to copper would prevent this method from being an option or Wilsons disease which is a genetic disorder in which excess copper builds up in the body. Fibroids and a distorted uterine cavity is another potential contraindication.

How quickly would my fertility return to normal?

As soon as the copper IUD is removed a woman’s fertility would return to normal. We would recommend having at least one normal menstrual cycle without the IUD being present before trying to conceive.

How are they fitted?

The procedure itself is very straightforward, similar to a smear, but the device is inserted through the cervical canal into the uterus. It is a procedure that we can perform in the clinic. If you would like to try this method, please do book an appointment. Continue with your previous method of contraception until you come to the clinic so that we know you are not pregnant. If you’re using condoms, please abstain from intercourse from your previous menstrual period. If you have any symptoms suggestive of an infection or have had a new partner in the last 18 months, please arrange to have a sexual health screen prior to your appointment.

Support

COVID19 has reduced access to many contraceptive services across the country impacting on women’s lives and reproductive health.

If you would like any advice, or to discuss your contraceptive options, please contact me at Hormone Health 92 Harley Street Clinic.

Dr Peers became a Consultant in Contraception and Reproductive Healthcare in 1996, and has years of experience managing complex contraceptive cases and helping women manage and maintain good health during and after the menopause.

Get in touch. We can help.

+44 (0)808 196 1901
hormonehealth@92Harleystreet.com

Would you like to see more blogs from Hormone Health? Click here

Edition 33: November News

WE ARE OPEN!

Lockdown 2:0 is upon us and we would like to take the opportunity to inform all of our patients that we are operating a ‘Business as usual’ service with all COVID precautions. The only difference is that partners are not recommended to attend in clinic appointments. We are continuing to offer face to face appointments if required and a full e-consultation service. Scans and blood tests will continue but can be deferred if patients prefer.

Read our Newsletter

Our November Newsletter has some great features this month including Premature Ovarian Failure (POI), Understanding and mitigating the consequences of the Coronavirus Pandemic, World Menopause Day, webinars, blogs and more.

Social Media & Blogs

They are a great source of up to date information with the latest news, facts and research surrounding women’s health. The Hormone Health blogs are often a good place for other information…

Facebook Twiter Our blog

Help us spread the word

If you think any of your friends or family would be interested in our newsletters, please share it with them or they can subscribe directly.

Premature Ovarian Insufficiency

Signs of the early menopause and what to do about it…

 Written by Hormone Health Associate Dr Imogen Shaw Consultant in women’s health and the menopause.

 What is POI? 

POI stands for Premature Ovarian Insufficiency; you may also hear it referred to as premature menopause or premature ovarian failure.  POI is a condition where the ovaries struggle to function correctly before the age of 40. The ovaries stop releasing eggs and stop producing hormones (estrogen, progesterone, testosterone).

The incidence of POI increases with age:

  • 1 in 10,000 women in their teens
  • 1 in 1,000 women in their twenties
  • 1 in 100 for women in their thirties.

During perimenopause, which is the transition period before menopause occurs, the ovaries produce fewer and fewer hormones until they run out of eggs to release, and a woman’s periods stop.

The menopause (when your periods stop) happens at an average age of 51 years. However, POI occurs more than 10 years before this due to prematurely declining ovarian function.

Diagnosis:

POI can be diagnosed in women under 40 years with irregular cycles and follicle-stimulating hormone (FSH) concentrations in the postmenopausal range. Any woman who has had no periods for four months or only a few throughout one year should have two measurements of blood FSH levels, at least six weeks apart, which should show elevated levels of FSH.

The causes of POI:

The vast majority of cases (90%) are spontaneous, no underlying causes found (also referred to as idiopathic). While psychologically, this can be hard to accept, it is essential to remember that it should in no way affect the treatment you are offered.

Known causes of POI are:

  • Autoimmune disease (5% of cases). This includes conditions such as underactive thyroid, type 1 diabetes, and Addison’s Disease. In these cases, the woman’s body makes antibodies that attack her ovaries.
  • Genetic conditions, such as Turner syndrome, Fragile X syndrome, or galactosemia.
  • Surgery to remove the ovaries
  • Treatment for cancer, such as radiation or chemotherapy
  • Infections such as mumps, TB, and malaria (although this is rare)

What are the symptoms? 

Many women with POI experience normal puberty and have regular periods before symptoms start. The symptoms of POI are the same as those seen at the menopause and may include:

  • Hot flushes
  • Night sweats
  • Tiredness and disrupted sleep
  • Reduced sex drive (libido)
  • Irritability or mood swings
  • Poor concentration or memory
  • Joint pain or stiffness
  • Changes to skin and hair
  • Painful sex because of the thinning and drying of the vagina
  • Dry eyes

What are the effects of POI on health?

POI can have an impact on different parts of the body.

Infertility

As the ovaries stop functioning properly, the chance of conceiving naturally is significantly reduced. However, there may be a small chance of spontaneous pregnancy, so your doctor should discuss the need for contraception with you.

Sex life

You may experience vaginal dryness, reduced libido, and pain during intercourse due to the low estrogen levels associated with POI, which may have a significant impact on your sex life, and relationships with your partner.

Bone, heart and brain.

Reduced estrogen levels do not only result in menopausal symptoms but can also affect the health of your:

Bones

POI is associated with reduced bone mineral density. Estrogen plays an integral part in bone density and helps your body equalise the balance between bone build up and bone break down. When estrogen production falls, bone breakdown occurs at a quicker rate than build up, leading to a condition called Osteoporosis. People with Osteoporosis are at increased risk of bone fractures.

Heart

POI is associated with an increased risk of developing heart disease. We also now know that POI leads to a higher rate of Cardiovascular disease, which is a disease of heart and blood vessels leading to a higher risk of strokes and heart attacks. Other changes, such as increased blood pressure or cholesterol, can also take place.

Brain

POI may have an impact on your memory. Some studies suggest that women under age 45 years who undergo bilateral oophorectomy and do not receive estrogen replacement are at increased risk for dementia and cognitive decline. 

A healthy lifestyle including exercise, cessation of smoking, limiting alcohol intake, maintaining a healthy diet, and weight can reduce the impact of POI on your bones, heart and brain. Your doctor can monitor the health of your bones and check on your bone density with a DEXA Scan if needed.

What are the options for treatment? 

 HORMONE REPLACEMENT THERAPY (HRT)

In women with POI, the ovaries no longer produce hormones (estrogen, progesterone, testosterone), which are needed for a healthy body. HRT aims to restore the levels of these hormones in your body to a similar level as women of the same age without POI, so improving the typical symptoms of POI (hot flushes, night sweats). HRT may have a role in the prevention of heart disease and protecting your bones. In women with POI, HRT is safe and does not increase the risk of breast cancer above the normal level for this age group.  

ANDROGEN THERAPY (testosterone)

Androgen therapy can be very helpful in some women as a treatment for the effects of POI on sex life, bones and memory, but studies are limited, and the long-term side-effects of androgen treatment are unknown. If androgen therapy is commenced, the treatment effect should be reviewed after 3-6 months, and stopped if no benefit experienced.

LOCAL TREATMENTS (vaginal estrogen cream/pessaries, lubricants)

Some women with POI experience significant sexual problems, either uncomfortable or painful intercourse from vaginal dryness or sexual changes such as altered libido and arousal. HRT may improve these symptoms. Lubricants are useful for the treatment of vaginal discomfort and painful sex due to vaginal dryness, whether HRT is being used or not.

What support is available? 

The leading UK charity supporting women with POI is The Daisy Network.

Your GP may also be able to provide you with details of NHS support groups or forums. For contact details of national patient organisations for infertility, you can ask your doctor, or contact fertilitynetworkuk.org

Get in touch. We can help.

+44 (0)808 196 1901
hormonehealth@92Harleystreet.com

Would you like to see more blogs from Hormone Health? Click here