Palpitations and heart thumps

Palpitations (bursts of rapid heartbeats) are another common symptom at this time and are not a sign that you are about to have a heart attack. Alcohol and smoking aggravate them. They settle with relaxation and removal of the hot flushes. Some may persist and cause more discomfort, and these may be treated further. Heart thumps (extra systoles) may appear first at this time, particularly when lying down after a heavy meal, after alcohol or aerated soft drinks, or smoking.

Emotional problems

There are many women who suffer from emotional change

There is a variety of explanations for why this occurs, but I do

not entirely agree with some psychiatrists’ views of the causes of the depression which is occurring as a flrst-up symptom in this age group of patients, that is those who have not been depressed either repeatedly or deeply before in their lives. I think this is because I see a different group of women. Psychiatrists see the more deeply depressed women.

I see women who come through the door and who have had no past history of depression and say ‘I’ve never felt like this before in my life. I am irritable and nasty with my family and husband and furthermore I know I’m doing it. I am over anxious. If I have to do something unexpected I am unable to cope with it.’ The psychiatrists state there is a mid-life crisis in both sexes. In addition the women get an extra hormonal thump, which produces added symptoms.

Real physical reasons

The patients I see have real physical reasons for being depressed — they are concerned about their state, their inability to control their flushes and, in addition, their change in sexuality. There are definite changes in the cells of the vagina and this may well affect comfort with intercourse. There may be a drop in libido at this time. In addition, some women are simply short of sleep due to the insomnia that occurs at this period. However, I feel we should look at the theories put forward for the reasons for depression at this time.

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Many women feel a sense of loss and guilt when they experience a loss of libido and this can contribute toward depression at the time of the menopause. This is particularly so when they have had a good sexual relationship with their partners.

While sexual intercourse improves relationships it is not the only factor. Many couples in their later years find that mutual respect, and the shared experiences of surviving the various ups and downs of life produce bonds that perhaps substitute for the loss of sexual experience. This is obviously a personal state of affairs which every couple must work out for themselves. It is important that those women who do not feel the same sexual desires that they felt in their youth do not feel they have nothing left to offer their partners. There is pressure within the community to have women believe that unless they are having intercourse into their seventies they are just not ‘with it’.

Change in attitudes

With the alteration of women’s self-image, and the change of attitude of society about their place, following reproductive failure, they and their partners are altering their expectation of this time of their life. Early surveys in our clinic obtained false information in this area until it was realised that women were uneasy about discussing personal sexual problems unless directly asked.

Standard menopause assessment and indexes, derived twenty-five or more years ago and still used to score symptoms, did not include libido or comfort with intercourse. This has changed. In many cases today, these features are the presenting symptoms, or the main reasons why many women have attended our clinics.

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After the clinicians meeting it was felt that the benefits of replacement therapy for women still outweighed the possible side effects; furthermore such problems had been rare in our clinics. In eleven years in a busy clinic at Prince Henry’s Hospital, we have had only one case of hyperplasia and no cases of cancer of the endometrium. We investigate all women with irregular or excessive bleeding and refer them to gynaecologists, so it is unlikely that we would miss one.

If oestrogen is given in excessive doses, taken continuously or if progestogen is not given with it, conditions may be set up which may lead to cancer in certain women. But progestogen produces a period, thereby clearing out the lining of the uterus so it does not get abnormally built up by the constant stimulation of the oestrogen.

Oestrogen is like any other therapy; all patients must be assessed individually. It should not be withheld from those who need it, nor should it be used indiscriminately. We have definite rules and routines of therapy in our clinics, worked out in the interests of women’s safety and based on work done in much larger population studies than we can do in Australia. These will almost certainly be the views of any conservative, well-informed doctor you consult.

Hormones are only given to relieve symptoms, that is we do not follow the practice used some time ago, of giving oestrogens to all women after the menopause.

Not all women will take oestrogen. The endocrinologists who helped me set up the clinics in the first place had told me that if I wanted to give women oestrogens I would have to sell them back their periods or I would run into problems. How right they were. To those women who say, ‘But I don’t want my periods back’, I can only reply, ‘You can’t have your cake and eat it. You can’t have the hormones of your youth without the disadvantages if you want to take it safely.’

The benefits must be weighed up against the risks. We have regular guidelines:

• we use the lowest dose which relieves symptoms.

• the oestrogen is never given without regular administration of the other hormone, progestogen (present in the monthly cycle when young), following which a small bleed often occurs.

• every year we wean patients off therapy over a month or so, and then remove therapy altogether to see if symptoms return and whether or not they need further treatment.

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Probably many factors are involved. One is the loss of hormones after the menopause. Exercise and diet are also important. Oestrogens are known to help in calcium retention and bone

formation, just as the male hormone, testosterone, does in the man. Women lose their hormones more suddenly, while male hormones taper off gradually into old age Osteoporosis in men, therefore, only seems to have become important in a much older age group. Some studies have suggested that oestrogen reduction in the body is in some way responsible for osteoporosis, and the fact that osteoporosis starts at the menopause certainly seems to confirm this. Galiagher and co-workers found that postmenopausal women lose calcium in their urine while they sleep, and they found that this could be totally reversed by the administration of daily oestrogens, an effect that was detectable within two weeks.

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There is no doubt that women tend to put on weight at this stage of their lives. It is due to many factors.

A change in metabolism Some women say ‘I hardly eat a thing’ or ‘I have not changed my intake.’ I believe every word of it, but if your weight is increasing, your intake is too much for your metabolism at this stage. Some women need to cut their intake to less than half to maintain their previous weight.

Less exercise Less exercise and a more sedentary existence sometimes creep up particularly for women who are not working outside the home. Children have left home, there is less housework and shopping to do, and you may also have given up your weekly game of tennis.

More leisure More leisure and increased alcohol consumption are likely, particularly when there is less call on your purse; you may be out playing bridge and eating afternoon teas, having a drink before dinner, etc – it all adds up. Whatever the cause, straighten yourself up.

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Always picture your immune system as strong, tough, powerfully aggressive, invincible, indomitable and unconquerable. Make sketches of your killer T cells and macrophages with wolflike fangs and jaws, and of die antibodies with sharp, dart-like points. See them rush at any virus and tear it to shreds.

Or you can symbolize your white cells as fierce white dogs or white tigers or as any fierce and aggressive animal that always wins.

Visualize the cold or flu viruses as small, weak, disorganized and disoriented. Never picture your ailment as strong, powerful, magical, evil, monstrous, gigantic or fear-inspiring. People who have symbolized a cold or flu as a lion or tiger, a giant or a monster, or a powerful spreading tree or rock have proved to be fearful of the ailment and to have a low level of confidence and belief in their immunocompetence.

Next, make a rough sketch of yourself in perfect health, free of all cold and flu symptoms. Sketch yourself as you were at the healthiest, fittest time of your life. Draw yourself loping along a beach, inhaling great quantities of pure air through unblocked nostrils. Feel complete faith in your ability to destroy any invading virus or bacteria.

Create clear, strong, vivid pictures of your white cells and of yourself in perfect health. Not only see yourself running along a beach but feel, hear, smell, taste and touch the scene. Experience each sensation. Smell the salty tang of drying seaweed, hear the scream of gulls and the roar of surf, feel the sea breeze in your face, the sun on your body, and the grains of sand under your bare feet.

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C and other essential nutrients by approximately forty per cent while caffeine also causes a zinc deficiency. Beverages containing caffeine include coffee, black and green tea, hot chocolate, cocoa and most cola drinks. The Pill, diuretics, anti-hypertension medication, prescription and “recreational” drugs and medications may also interfere with absorption of nutrients essential to the body’s cold-fighting process.

Also ranking high among foods to avoid are fats of all types. A high dietary intake of fat, especially polyunsaturated fatty acids (pressed vegetable oils) and hydrogenated vegetable oils, has been shown to result in lymphoid atrophy and suppressed antibody response to antigens in lab animals. All indications are that fatty acids enhance synthesis of prostaglandins, a surfeit of which are believed to directly suppress the immune system.

However, there are several different types of prostaglandins and certain prostaglandins are utilized by the immune system itself to create inflammation. Prostaglandins are manufactured from linoleic acid, a fatty acid which is transformed into arachidonic acid in the body and is stored in the body’s fat cells.

Linoleic acid is supplied by legumes and whole grains such as oatmeal. If, however, you do not eat a sufficiency of these two foods, you can obtain sufficient linoleic acid by adding one teaspoon of cold-pressed sunflower or saf-flower seed oils to your diet each day. These oils can be used as a dressing on salads or can be used in cooking or in baked goods. (Olive oil or peanut butter are not considered good sources of linoleic acid.) Nonetheless, a single bowl of oatmeal will usually supply our entire linoleic acid needs for the day.

A high-fat diet also inhibits production of “Intrinsic Factor” in the gastric juices which is needed for the absorption of vitamin B12. This nutrient, as you may recall from Chapter 5 is one of a variety of R-complex vitamins which aids the immune system in battling colds and flu. Others include vitamins A, C, E, the entire B-complex and the mineral zinc.

It is foods of animal origin, particularly meat, whole milk dairy products and eggs that are high in fat and low in many vitamins essential to immunocompetence. Refined carbohydrates, such as white flour, sugar and sweeteners of all kinds, are also almost valueless in providing nutritional support. All traces of zinc and other nutrients have been refined out of them. Another problem is that these are all acid-forming foods which interfere with absorption of zinc, and they restrict availability of zinc to the body.

The best nutritional support is provided by eating the 80-10-10 way, meaning that 80 percent of our calories should come from complex carbohydrates (fresh, unprocessed vegetables, fruits, whole grains, nuts, seeds and legumes); not more than ten percent should be derived from fats (preferably from unprocessed fats contained in whole grains, avocados, nuts and seeds); and ten percent should come from protein, preferably from legumes, nuts, seeds, whole grains, white or oily fish, egg whites or very low fat dairy foods such as plain yogurt and cottage cheese.

Eating the 80-10-10 way provides a diet high in vitamins A, C, E and the B-complex and in zinc and most other essential minerals. It also provides sufficient protein for antibody production.

However, it’s important that your diet contain an abundance of deep green and yellow vegetables plus green leafy vegetables and both fruits and vegetables which are yellow-to-red or bright orange in color. These foods art all high in beta-carotene, a precursor of vitamin A which is essential to the integrity of mucous membranes lining the nasal air passages.

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The consensus of many similar studies is that vitamin C stimulates production of interferon; that it enhances the ability of the thymus gland to produce T cells; that it helps detoxify surplus histamine; and that it bolsters bacterial phagocytosis (ability of phagocytes to destroy bacteria). Doses of 2 to 3 grams have produced significant increases in immunocompetence.

As a result, vitamin C has become the best known dietary factor affecting immunity. On coming down with a cold, many people are now taking C instead of aspirin. Which is understandable when you consider that several carefully-conducted medical studies have shown that a mild viral infection, such as a smallpox inoculation, causes a significant depletion in vitamins A and C in the bloodstream.

While the results of studies like those just quoted have confirmed the benefits of vitamins A and C, and of zinc in treating colds, the lack of any large-scale scientifically endorsed proof seems due more to the nature of the scientific method than to any doubt about the nutrient’s effectiveness. Any study is limited to testing only a single variable. Thus only a single vitamin or mineral can be tested at a time. By contrast, vitamins and minerals interact biologically, and work synergistically with each other, to produce results far greater than that of any single nutrient acting alone. Taken together, vitamins A, C, E and the B-complex plus zinc and other key minerals, appear to complement the other to produce overall results far in excess of any single nutrient studies so far recorded.

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By comparison, the onset of flu symptoms are more sudden and severe. Fever may quickly soar to the 102° to 104°F range. Headaches are common and prolonged. Muscular aches and pains appear throughout the body. A sore throat is a frequent symptom. Bouts of chill and shivering often alternate between periods of sweating. The eyes are sore, the face is often flushed, and the skin hot and moist. The victim feels weak and fatigued and appetite may fade. Almost 90 percent of flu victims are afflicted with dry, hacking cough and, often, a chest discomfort also. Existence of a local flu epidemic supports the probability that the diagnosis of influenza is correct

Alarming as they may appear, flu symptoms pose little risk to a healthy adult or child. In any case, medical science is unable to cure or alleviate either a common cold or flu since antibiotics are ineffective against viruses.

Because both cold and flu viruses may create raw, irritated tissue, and also overload the immune system, a bacterial infection of the nose, sinuses, throat or chest may follow a cold or flu.

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Careful diary-keeping is a great help in identifying the exact nature of tension or migraine headache triggers. Women should include exact dates on which menstruation begins and ends. After three months, you should begin to see a pattern which can help to identify migraine triggers and to avoid them.

Diary-keeping coupled with careful observation also can help identify tension headache triggers. For example, you may find that it is not typing that causes your headache but the way you sit or slouch over the typewriter. Or it could be due to inadequate lighting. Identifying and avoiding headache triggers has brought relief to many.

Here is a brief rundown of the principal categories of headache triggers.

Physical and environmental triggers. Smog-containing sulphur dioxide, commonly emitted from refineries, steel and paper mills or fertilizer plants, has been scientifically confirmed as a common migraine trigger. Fumes and odors from soap, detergent, perfume, after-shave lotion, and household chemicals and pesticides, when inhaled in an enclosed room, can set off migraine in some people.

Other common environmental triggers include glaring or flickering lights or bright outdoor sunshine (wear sunglasses and a hat with a brim).

Stale air in offices and rooms, especially if smoke-filled, is a potential headache trigger. Others include: odorless carbon monoxide leaks from car exhausts or heating equipment; rapid decreases in barometric pressure; wearing a swim mask or goggles—this can set off a headache one to two hours later, sudden weather changes, especially onset of a hot, dry wind. Loud, jarring noises keep the body continually stressed, while a constant noise prevents relaxation. Temporary headaches due to high elevation are also common among mountain hikers and climbers. Usually mild, the headaches customarily affect the entire head. Occasionally, an altitude headache is confined to one side, and can become as severe as a migraine. Altitude headaches normally disappear on descending.

Long distance flights, especially from east to west, can trigger migraine in susceptible persons. To help avoid headaches when flying, drink frequent glasses of water, avoid alcohol, eat lightly, sit in an aisle seat so that you can stand up and stretch, and rest upon arrival. OTC painkillers are freely available on most flights.

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