The answer to these questions is, ‘It depends on your symptoms’. If you are not bothered by menopausal symptoms, nor at risk of developing osteoporosis or arterial disease, then don’t feel pressured by your friends, family or the media to take it. You do not need it, and to take it would be an unnecessary medical intervention. Despite what the papers say, it will not keep you ‘young and sexy forever’, and if this is why you want to take it perhaps you should look carefully at yourself, your relationships and your underlying fears.

If, however, you are being bothered by hot flushes, night sweats, and the various early signs of the menopause, then you might want to start HRT as soon as these signs start having a negative effect on your life. This may well be while you are still having periods, but you can still start HRT, although it may be difficult to get the level of treatment exactly right.

Although you may accept all this, some women find the higher rate of side-effects and the irregular bleeds put them off HRT completely and they are then reluctant to consider it again in a few years’ time when different symptoms occur.

If you have been put off HRT for this reason, you may find that, in the meantime, new forms of HRT have become available that would reduce the problem. Again, talk to your doctor about this.

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Any woman on the Pill should come off it a month before surgery, substituting a non-hormonal method of contraception, such as a condom or diaphragm in the meantime. Women who smoke should stop at least a week before a hysterectomy. They should also consider a permanent break from smoking as their risk of heart disease and osteoporosis is likely to increase as a result of the surgery, and smoking will increase this risk still further.

A GnRH agonist may be prescribed prior to surgery in a bid to reduce the size of any fibroids a woman may have. When this approach was systematically studied in 142 women, only half of whom received a GnRH agonist, the results were encouraging. The surgery was less likely to be difficult in the treated women who also experienced significantly less blood loss on average. It has been suggested that the beneficial effect of GnRH agonists is due partly to their ability to shrink fibroids and partly to their reduction of uterine blood flow.

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Have you noticed that, even without looking at a watch, we usually wake up at about the same time every morning and feel sleepy and go to bed nearly the same time each night? We do not need to know the time to do all these things. Somehow our body knows the time, as if we have a clock inside. This internal clock is called the biological clock.

Jet lag is a similar example. The traveller who flies from one side of a continent to another is unable to reset his biological clock immediately. The clock is still running at the same time back home; hence there is a feeling of disharmony. Sleeping and eating at a new time disrupt the jet traveller’s old pattern. It may take a few days to get used to the new time. There is one way to reduce the effect of jet lag and that is to reset your biological clock closer to the local time of your destination a few days before travelling. For people travelling westward, you should stay up later and later each night for a few nights before departure. For people travelling eastward, you should go to bed earlier and earlier each night instead. By doing so you may reduce the gap between your biological clock and the new local time of your destination.

Jet lag can become a problem for someone who has to make frequent trips overseas, especially if he has to make important decisions immediately on arrival. The inadequacy of performance after travelling across different time zones has led the military and many large corporations to forbid high level decision-making after a long flight until after a proper resting time. The ‘rest formula’ now used by the International Civil Aviation Organization, developed by Dr L. E. Buley, takes into account the hours of the day the traveller departed and arrived, the number of time zones flown through, and the number of hours travelled:

Rest time (days) – [ 7/2 + (Z - 4) +Cd + Ca ]/10

T is the travel times in hours, Z is the number of time zones, Cd and Ca are coefficients of departure and arrival which introduce gains and losses of time.

If one flies from Melbourne to London, departing Melbourne at 1300 hours (Eastern Standard Time) and arriving London at 0555 (Greenwich Mean Time), the rest period is calculated as follows:

Rest time =[26/2 + (10-4) + 1 + 3]/10 = 2.3 days.

An overseas trip is one of the very few instances in which sleeping pills are to be recommended. A drug that is short acting is preferred so as not to cause drowsiness on arrival.

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