Monthly Archives: October 2022

When deciding whether to havehormone replacement therapy (HRT), it's important to understand the benefits and risks.

Many studies on HRTpublished over the past 15 yearshighlight the potential risks. As a result, some women and doctors have been reluctant to use HRT.

But recent evidence says that the risks of HRT are small and are usually outweighed by the benefits.

The main benefit of HRT is that it can help relieve most menopausal symptoms, such as:

HRT can also help prevent thinning of the bones, which can lead to fracture (osteoporosis). Osteoporosis is more common after the menopause.

The benefits of HRT usually outweigh the risks for most women.

The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks.

Speak to a GP if you're thinking about starting HRT or you're already taking it, and you're worried about any risks.

There is little or no change in the risk of breast cancer if you take oestrogen-only HRT.

Combined HRT can be associated with a small increase in the risk of breast cancer.

The increased risk is related to how long you take HRT, and it falls after you stop taking it.

Because of therisk of breast cancer, it's especially important to attend all yourbreast cancer screening appointments if you're taking HRT.

The evidence shows that:

HRT does not significantly increase the risk ofcardiovascular disease (includingheart disease andstrokes)when started before 60 years of age, and may reduce your risk.

TakingHRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.

Page last reviewed: 09 September 2019Next review due: 09 September 2022

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Hormone replacement therapy (HRT) - Benefits and risks - NHS

What is thyroid hormone replacement therapy?

Thyroid hormone therapy is the use of manmade thyroid hormones to raise abnormally low levels of natural thyroid hormones in the body. Thyroid hormone is usually given in pill form and is often used to treat an underactive thyroid that is secreting little or no thyroid hormones. The most commonly prescribed thyroid hormone replacement is pure synthetic thyroxine (T4).

Thyroid hormone therapy is generally prescribed when your thyroid is not making enough thyroid hormone naturally. This is a condition referred to as hypothyroidism. Other reasons for using thyroid hormone therapy may rarely include:

To control the growth of the enlarged thyroid gland (also called goiter)

To control the growth of nodules on the thyroid gland

Treatment after the removal of the thyroid for benign or malignant disease

After treatment of hyperthyroidism by radioactive iodine ablation

Healthcare providers do careful blood testing to find the proper dose of hormone replacement therapy for each person.The blood tests reveal levels of thyroid hormones in the blood, as well as thyroid-stimulating hormone (TSH)released by the pituitary gland. The pituitary gland plays an integral role in the functioning of the thyroid gland. It controls how much thyroid hormone is released by making TSH that "stimulates" the thyroid. Increased levels of TSH may indicate that you have an underactive thyroid or that thyroid hormone replacement needs to be increased.

You will have lab tests to measure levels of thyroid hormones and TSH. Hypothyroidism can be a progressive disease. This needs dosage increases over time.

To make sure that your thyroid hormone replacement works properly, consider the following recommendations:

Maintain regular visits to your healthcare provider.

Take your thyroid medicine at least 1 hour before breakfast and any calcium or iron medicines you may take. Or take at bedtime, or at least 3 hours after eating or taking any calcium or iron medicines.

Tell your healthcare providerof your thyroid hormone treatment before beginning treatment for any other disease. Some treatments for other conditions or diseases can affect the dosage of thyroid hormone therapy.

Let your healthcare provider know if you become pregnant.

Tell your healthcare provider of any new symptoms that may arise.

Tellall healthcare providers of your thyroid condition and medicine dosage.

See the article here:
Thyroid Hormone Replacement Therapy | Johns Hopkins Medicine

Two in three perimenopausal women may not report headache, so doctors are urged to ask patients about symptoms.

A headache specialist has urged doctors to ask perimenopausal patients about headache symptoms, because migraines are often undiagnosed and poorly managed in these women.

There were also important considerations for women taking HRT, the headache and womens health specialist Professor Anne MacGregor told the Australasian Menopause Society Congress in Cairns last month.

Migraine symptoms become more common when women reach menopause and can have severe impacts on quality of life, but few women report migraine as a symptom of menopause. Among women who attended a menopause clinic, 62% experienced headache but did not spontaneously report it, Professor MacGregor told the conference.

And among women at the clinic who experienced migraine, 79% reported very severe or substantial disability, said Professor MacGregor, from the Queen Mary University of London.

Our research of women with migraine attending amenopauseclinic suggests that women are not receiving optimal treatment for symptomatic treatment of migraine attacks, she said.

Migraine with or without aura does not contraindicate the use of hormone replacement therapy, but transdermal HRT was preferable, Professor MacGregor said.

Hormone replacement therapy could help migraine symptoms, but only in the context of prescribing HRT for management of vasomotor symptoms in women with migraine, she said.

Migraine can be worsened by changes in hormones, so providing stable hormone levels using transdermal oestrogen and ideally continuous progestogen is best.

Professor MacGregor told the conference that if patients experienced a new-onset migraine with aura, doctors should firstly exclude transient ischemic attack and reassure the patient.

She then recommended changing the patients HRT to a transdermal form and prescribing the lowest effective dose of estrogen to control vasomotor symptoms, and consider non-hormonal options if aura does not resolve or increases in frequency.

Professor MacGregor told TMR there were several alternatives to HRT that may also be helpful when patients experience migraine.

Non-hormonal options that benefit both migraine and vasomotor symptoms ofmenopauseinclude losing weight if obese, exercise, cognitive behavioural therapy and prescribed medications including SSRIs and SNRIs, particularly venlafaxine.

Professor MacGregor told the conference that migraine was a risk factor for the onset of menopause and could predict more frequent vasomotor symptoms associated with anxiety, depression and sleep disturbance.

Professor MacGregor wrote in a review in Maturitas that perimenstrual estrogen withdrawal is implicated in thepathophysiologyof menstrual migraine, with increased prevalence of migraine in perimenopause associated with unpredictable estrogen fluctuations.

Professor MacGregor said general practitioners should ask women about migraine symptoms, particularly sinus headache.

Perimenopausal women should routinely be asked about symptoms suggestive of migraine bearing in mind that the most common misdiagnosis is sinusitis which should then be managed appropriately according to national guidelines.

Professor MacGregor said for most women, migraine developed during their teens and 20s, became more prevalent during perimenopause and gradually improved with time after menopause. A few women develop migraine for the first time during perimenopause, she said.

Migraine has a global prevalence of 19% in women and 9% in men, she wrote.

Migraine without aura is the most prevalent type, affecting 70-80% of people with migraine.

The three best predictors for diagnosing migraine without aura are photophobia, disability and nausea: people who report two of these symptoms have an 81% probability of migraine, with the presence of three symptoms increasing the probability to 93%.

Original post:
Prescribing HRT in women with migraine The Medical Republic - The Medical Republic

Carri Holton, MSN, WHNP-BC, Department of Pediatric & Adolescent Gynecology at Childrens Hospital Colorado, gave a presentation on gynecologic care for adolescent patients at the NPWH 25th Annual Premier Women's Healthcare Conference in Houston, Texas, from September 29 to October 2.1

Holton first outlined how health care providers can provide preventive health screenings and offer guidance to adolescents, teens, and parents in pediatric gynecology. Conditions such as pediatric vulvovaginitis, lichen sclerosis, genital injuries, labial adhesions, congenital anomalies in the reproductive system, menstrual suppression, tumors, premenstrual syndrome and premenstrual dysphoric disorder, and breast problems in youths are treated via pediatric gynecology, as is fertility preservation or hormone replacement.

During an office evaluation, there should be a welcoming environment for adolescent patients, according to Holton. Health care providers will require technical skills to complete hymen exams, single-digit exams, and smaller speculums. They will also need to have the patience to listen to adolescents and parents, along with learning the history of their patients.

Confidentiality was also discussed. Holton noted that adolescents must be made aware of instances when information is not confidential, such as suicidal or homicidal thoughts. Minor consent laws should be known, as many states allow minors to consent to family planning, pregnancy care, substance use related care, and outpatient mental health services. All states allow minors to consent to sexually transmitted infection testing.

When arranging and performing an adolescent exam, the decision should be between the adolescent and the provider, though there should be a chaperone present. Providers should explain all components of the exam to the patient and parent. Patients should be reassured that they are in control of their body and the exam can be stopped at any time.

When moving onto the next step, providers should ask permission to pull the sheet back. Holton reminded them to be explaining female anatomy with proper terms, educating parents and patients. Breasts and pubic hair should be examined for Tanner staging, and external genitalia should be examined for normal anatomy.

In the presentation, Holton discussed normal pubertal development along with abnormalities, and encouraged attendees to learn this information so that they may recognize signs of abnormal development. Providers need to first identify the cause then determine treatment. This could include hormone replacement therapy in cases of primary ovarian insufficiency.

Holton also outlined instances of physiologic anovulationwhen slow maturation occurs in anovulatory cycles. This can lead to noncyclic, unpredictable, and inconsistent bleeding. In cases where bleeding is too much, adolescents should see an oncologist for testing, especially in cases of concerning history with bleeding disorders in the individual or family.

In cases of mild bleeding without anemia, providers should reassure patients, provide them with prophylactic iron supplementation, and offer hormonal contraceptives if desired. In moderate bleeding with anemia, providers should give patients combined oral contraceptives, micronized oral progesterone, depo Provera injection, levonorgestrel (LNg) intrauterine device (IUD), and iron supplementation.

Further treatments, along with hospitalization and blood transfusion, may be needed in cases of severe bleeding. In all cases, Holton stated that iron supplementation should be given.

Holton also discussed polycystic ovary syndrome (PCOS), reminding attendees that every case is different. Holton also noted that PCOS is not caused by ovarian cysts or being overweight, and that much is still unknown about PCOS. Diagnoses may be given as irregular periods, and can present as amenorrhea, oligomenorrhea, and chaotic periods.

Treatment for PCOS will vary based on concerns, as it can lead to metabolic concerns, acne, dermatologic concerns, and nutrition concerns. When these concerns arise, screenings should establish a rapport in the first visit. Repeated screenings should at first take place every 3 months, then every 3 to 12 months depending on the patient.

Holton lastly talked about dysmenorrhea and endometriosis. Dysmenorrhea is painful menstruation, often increasing risk of anxiety and depression. It can be managed with dietary, vitamin, and herbal treatments along with exercise and yoga, or with pharmacologic interventions.

Dysmenorrhea is often caused by endometriosis. Risk factors of endometriosis include earlier menarche, nulliparity, shorter menstrual cycles, childhood sexual and physical abuse, and more. To treat endometriosis, Holton recommended both surgical and medical treatments. Complementary and alternative therapies may also reduce symptoms.

Reference

Originally posted here:
Caring for the gynecologic needs of the adolescent patient - Contemporary Obgyn

EVEN if you like a bit of alone time, being lonely is very different, and can be very damaging.

In fact, loneliness can significantly affect your health and wellbeing and its something none of us should learn to live with.

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Luckily, there is lots of help out there, and there are small changes you can make yourself to tackle it, from speaking to the Samaritans to joining a club to meet new people.

Youre never truly alone!

Here are this weeks reader questions...

Q: IS there help for someone in their late 30s starting to go through perimenopause?

A: Premature ovarian failure insufficiency is a condition that occurs when your ovaries are no longer working properly and youre under the age of 40.

This affects approximately one per cent of women. It usually means that your periods stop or become irregular, and you may also experience menopause symptoms.

The term early menopause is used when periods stop between the ages of 40 and 45.

You say that youre in your late thirties, so its possible that you could fall into either of these groups.

The most important thing is for you to seek medical help here and get a diagnosis.

While its not normally recommended for women over the age of 45 to have blood tests to look for menopause, for women under 45 who are having symptoms it is.

This is because its important to make the diagnosis because its vital that women receive the correct hormonal replacement therapy, or HRT.

We often talk about how HRT is safe for most women and the benefits outweigh the risks, but that calculation is different in women under 45, where almost definitely there are huge benefits to taking HRT that massively outweigh any risk.

The next step for you is to see your GP, and keep a log of the symptoms youve been having, and Id expect your GP to do a series of blood tests spread out over time to find out your levels of FSH, or follicular stimulating hormone.

If these levels are high, it would suggest youre experiencing premature ovarian insufficiency.

Q: MY metronidazole prescription finished today. Ive had two days of awful abdominal pain, sweats and now kidney pain.

A: It sounds possible youve had an allergic reaction to the metronidazole.

Serious side effects from this antibiotic medication are rare and happen in fewer than one in 1,000 people, however the symptoms you describe after taking metronidazole suggest an adverse reaction, and this requires medical attention.

If all of your symptoms have now resolved, it may be that your GP decides further tests arent necessary, but if your symptoms are still ongoing youll need blood tests to check things like the health of your liver and kidneys and you should be monitored.

Metronidazole is a slightly unusual antibiotic, as it affects our bodys ability to metabolise alcohol.

So whenever it is prescribed, you should receive information and advice not to drink alcohol when taking the medicine, and to wait for two days afterwards before drinking alcohol, as this allows the metronidazole to leave your body.

Q: NO one has helped me in a long time what should I do? Ive had cancer, I cant speak to my family about it, I have no help or support.

Im scared, alone and getting depressed.

A: Anybody who has cancer should be able to access help and support from the cancer specialist nurse.

The team looking after you for your cancer should be able to put you in touch if you havent been given their contact details already.

Usually there are also charities which provide peer support, such as online chat rooms. A diagnosis of cancer is a life-changing event which not only affects our physical health but our mental health too.

It impacts our relationships, our ability to do our jobs and every aspect of our social life.

Nobody should feel that they are on the cancer journey alone, as there is always help and support available.

The first port of call if youre feeling confused and overwhelmed is just to speak to your GP and let them help you in creating a support system, as you will need this.

It also opens up the conversation around loneliness, which we can think of as a health condition on its own now, thanks to new and ongoing research.

We know loneliness affects every aspect of a persons physical and mental health.

It has even been said that loneliness is as risky to a persons health as smoking.

Loneliness requires treatment.

Your GP will be able to let you know about what befriending services are available locally, and you can usually get some advice from the charity Age UK as well.

Please dont suffer alone or in silence. A problem shared is a problem halved I really believe that saying to be true.

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Q: CAN you give me some advice on how to treat adult acne?

Acne can be a real pain for adults.

We tend to think of it as a condition that affects teenagers, but especially in women it is quite common for acne to persist into adulthood.

Acne over the age of 25 is termed adult acne, while some people get it for the first time as an adult, and this is termed adult-onset acne.

It can range from a few spots on the face, neck, back or chest, to more severe cases, and acne which is causing scarring should be treated by a healthcare professional without delay.

For more simple acne which is white, and blackheads with no scarring, its fine to try over-the-counter remedies first.

But if these arent helping its a good idea to see your GP.It is caused by the glands in the skin producing too much oil and at the same time dead skin cells build up and plug the pores, causing blockages.

A type of bacteria which lives on everyones skin can then cause you some further problems.

Whenever treating acne, the first things to think of are the basics.

Simple things such as cleansing your skin well twice a day, eating healthy and nutritious foods, maintaining good hydration levels, and using a simple oil-free moisturiser are all important.

Depending on the type of acne you have, and the pattern whether it flares up during your period and what treatments youve unsuccessfully tried the treatment strategy will differ for different people.

Talk to your pharmacist, who can assess what would be a good next step based on what youve tried already and if this isnt helping, the next step is to see your GP.

Sometimes people require an oral medication called Roaccutane, which can only be prescribed by a dermatologist.

I cannot stress enough that if you have acne which is causing scarring, you should see your GP without delay.

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Im a GP heres the best way to treat acne and when to see a doctor... - The US Sun

(STACKER) In his 2010 book, The Emperor of Maladies, Siddhartha Mukherjee called cancer not one disease but many diseases sharing a fundamental feature: the abnormal growth of cells. What was at one point in history (not so far removed from our own), a whispered-about illness has become the target of a global effort to thwart its onset.

Certain forms of cancer are more common than others, notably in late-stage development.Stacker analyzed cancer incidence data from the National Cancer Institute and CDC to look at where the five most common forms of cancer are most prevalent.

The annual averages in each slide are calculated from data compiled between 2014 and 2018, and have been adjusted for patient age. The data was adjusted to account for the increased likelihood of older people developing cancer, and the state-by-state maps reflect the rates of each type of cancer per 100,000 people.

The following list is derived from the National Institutes of Healths 2022 projection estimates for the most commonly diagnosed cancers in the U.S., though the projection totals themselves are not included as a data point; a direct comparison would be misleading because this dataset uses compiled and age-adjusted historical data.

Cancer incidence, survival, and mortality rates are population-based indicators of progress against cancer. The mortality-to-incidence ratio can be broadly defined as the percentage of death certificates that include the persons cancer diagnosis and specify the type of cancer. However, the mortality-to-incidence ratio should not necessarily be interpreted as the survival rate. A cancer diagnosis on a death certificate could have happened at any point in the past and does not necessarily mean the person died of cancer.

Stacker also looked at risk factors for these common cancers, ways to reduce risk, and methods for cancer screening.

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Average national incidences per year: 49,438 Percent of incidences in late-stage: 15.0% Average annual mortality count: 5,428 Mortality-to-incidence ratio: 11.0%

The word melanoma means black tumor. Its development begins in melanocytesthe cells that produce the pigment melanin. Most people think of melanoma as a type of skin cancer, because it can form in moles on the skin. But it can also form in other pigmented tissues, such as those in the eye or intestine.

Melanoma is less common than other types of skin cancer, but it is more likely than other types of skin cancer to grow and metastasize, or spread to other organs. The most common risk factors for melanoma include exposure to ultraviolet light, having many moles or freckles, having lighter hair, and having a family or personal history of melanoma. The use of tanning beds and sun lamps also increases melanoma risk.

The best ways to prevent melanoma are using sunscreen, wearing sun protective clothing and sunglasses, and seeking shade during midday, when the sun is at its strongest.

Average national incidences per year: 75,374 Percent of incidences in late-stage: 57.4% Average annual mortality count: 27,717 Mortality-to-incidence ratio: 36.8%

Colorectal cancer develops as malignant cells grow and accumulate in the colon rectum, and usually present as a growth called a polyp. Risk factors for colorectal cancer include smoking, obesity, age, and family history.

Physical activity, combination hormone replacement therapy, and aspirin reduce the risk of colon cancer. Procedures such as colonoscopy and sigmoidoscopy can find polyps, so the doctor can remove them before they become cancerous. The recommended age for men to begin regular colonoscopies, once 50, is now 45. Fecal occult blood tests screen for blood hidden in the stool, which may be a sign of colorectal cancer.

Average national incidences per year: 115,218 Percent of incidences in late-stage: 70.4% Average annual mortality count: 78,841 Mortality-to-incidence ratio: 68.4%

Lung cancer is the third most common kind of cancer in the U.S., according to the NIH, and the leading cause of cancer death in both men and women. Smoking and exposure to secondhand smoke are the most common risk factors associated with lung cancer. Although most cases of lung cancer are caused by smoking, nonsmokers can get lung cancer, too.

There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer. The bronchi, the two tubes that lead from the trachea to the lungs, are sometimes also involved in lung cancer. Screening tests for lung cancer are in clinical trials, though LDCT scans have been shown to decrease the risk of death in heavy smokers.

Average national incidences per year: 200,677 Percent of incidences in late-stage: 20.6% Average annual mortality count: 30,566 Mortality-to-incidence ratio: 15.2%

Prostate cancer is the second most common cancer among men in the U.S. One in eight men in the U.S. will be diagnosed with this type of cancer. The biggest risk factors for prostate cancer are age, race, and family history. It is more common in men over 50, and in Black men compared to white men. Most men diagnosed with prostate cancer do not die of it, because the majority of prostate cancers grow and spread slowly.

Average national incidences per year: 249,261 Percent of incidences in late-stage: 31.9% Average annual mortality count: 41,951 Mortality-to-incidence ratio: 16.8%

Breast cancer is the second most common type of cancer in women in the U.S. It is the second leading cause of cancer death in women, after lung cancer. Older age, a family or personal history of breast cancer, dense breast tissue, obesity, and the use of hormone replacement therapy for the treatment of menopausal symptoms can increase the risk of breast cancer.

Mammography can detect tumors in the breast, even before they have spread to other organs. Mammograms are recommended for women ages 45-54 yearly, and every two years thereafter, except in cases of higher risk factors.

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State-by-state prevalence of the 5 most common types of cancer - KFOR Oklahoma City