Information on popular complementary and alternative medical topics

If you are at risk of developing osteoporosis you should start within about five years of the menopause for maximum effect, as these are the years of greatest bone loss; catch it then and your risks of a fractured hip or vertebra of the spine are greatly reduced. However, even starting much later will still give some benefit, and there are plenty of women who start after the age of 70 and still gain great benefit. There really is no time at which you are too old to start.

Much more research is needed into the effectiveness of HRT in older women, as most doctors in the UK seem reluctant to prescribe it to a woman over 65. This is a pity, as it can be of great benefit to them. The risk of developing osteoporosis and heart disease is much greater over the age of 65, so this would seem a good time of life to be taking HRT. Obviously, women with a uterus do not like the idea of returning to a monthly bleed, which may be heavy or painful, and they may also experience breast tenderness and leg cramps. An increase in sexuality can be quite disturbing after several years without it. This is balanced against an increased sense of wellbeing, less stiffness in joints and muscles, and more energy. Once again, it is a question of balancing the advantages to you against the disadvantages, and when no-bleed HRT is in general use this may greatly affect how older women feel about it.

How long you stay on HRT will depend on you, your symptoms and your long-term risks. For most women, two years is about average for hot flushes, etc, but if they return when you stop the HRT, then you will probably want to keep it on for a while longer. You may be one of those women who need HRT for five years, or even much longer, to keep flushes at bay.

For relief of vaginal dryness, vaginitis and recurrent vaginal infections, you will probably want to stay on HRT for as long as you choose to remain sexually active. Sex doesn’t have to stop in your fifties! For conditions which simply become worse as the years go by, such as incontinence,

osteoporosis and arterial disease, you may decide to stay on HRT for years, perhaps for the whole of your life. If you don’t like the idea of taking it for so long, it is thought that even five years’ treatment in the years immediately after the menopause will considerably reduce your chances of an osteoporotic fracture.

In the end, you will continue for as long as the benefits to you appear to outweigh the disadvantages or risks. Sadly, the majority of women stop taking HRT after about six months, perhaps because of side-effects, or a return of monthly periods, or because of scare stories in the media. In reality, there is no reason why most women should not be able to remain on it indefinitely. Should you develop conditions such as a coronary thrombosis, blood clotting, gallbladder disease, cancer of the breast or uterus or ovary, fiver or kidney disease, or if you have a big operation like a hip replacement, your doctor will probably advise you to stop taking it. Some doctors, however, feel HRT may safely be continued even in these circumstances, especially if coming off it might reduce your quality of life significantly more than suffering these various other diseases would. As with everything medical, in the end when you start taking HRT, and how long you remain on it, should be a joint decision made between you and your doctor.

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The research team was surprised to find how strikingly beneficial hysterectomy was for symptom relief, and concluded that ‘hysterectomy was associated with more marked improvement in symptoms and quality of life than nonsurgical therapy’. The women who had hysterectomies reported significant relief from bleeding problems, pelvic and back pain, pain during intercourse, abdominal swelling and urinary problems. Those who felt they benefited most from the surgery were those who had been most impaired by their symptoms. This impairment took the form of persistent discomfort or limitations on activity.

The study also found much lower rates of adverse effects of hysterectomy than expected. Earlier studies had reported problems with passing urine in 20-30% of women after hysterectomy, but the Maine study found this occurred in only 4%. Other studies have reported diminished sexual function in 15-30%, but although 7% of the Maine women reported being bothered by less interest in sex after their hysterectomy, only 1% reported less enjoyment of sexual activity, and the majority reported increased interest in, and enjoyment of, sex. Persistence of pelvic pain after hysterectomy has been reported to occur in 22% of women, but in Maine the figure was 5%. Importantly, 82% of women in the Maine study felt they had a choice about having the hysterectomy and, for most, six or more months elapsed between the decision to have surgery and the actual operation.

As a check on possible biases that might explain these sorts of findings, the Maine study authors looked at eligible patients who were not referred by their doctors to participate in the trial. They found that patients not in the study were more likely to feel that they had no choice about having a hysterectomy, and their mental health assessments were less positive than those of the women who had participated. It is possible that doctors selectively referred patients to the trial who were more involved in the treatment strategy and in a better state of mental health. It is also possible that improvements in surgical techniques and post-operative care are responsible for the more positive results that seem to be occurring. In the light of these uncertainties, the authors recommended that their study be repeated in other parts of the US.

Recent Australian research on the outcomes of hysterectomy has also found high levels of satisfaction among women having the operation, although this was tempered by the belief that some new symptoms had arisen which were caused by the surgery itself. Research by an Australian team from the University of Newcastle and Macquarie University, published in the British Journal of Obstetrics and Gynaecology in 1991, asked women who had had a hysterectomy between two and ten years earlier to describe the impact of their experience. Of 175 women interviewed, 97% said the hysterectomy was worth the trouble and 88% said they would recommend a hysterectomy to others with similar problems, given their experience of it. The single most important benefit for 32% of the women was relief from heavy periods; for 25% it was relief from pain or painful periods; and for 4% it was improved emotional well-being.

An earlier Australian study, in which over 800 women who had had a hysterectomy (abdominal or vaginal) in New South Wales in 1976 or 1977 responded to a questionnaire, found that only about half were enthusiastic or very pleased that they had undergone the procedure. About 11% were not satisfied with the outcome of the operation and almost 12% complained of poor doctor or nurse communication. Post-operative recovery was frequently longer than expected, with 70% requiring up to three months for a return to normal activities and 16% more than six months. One impact that favourably impressed many women was sexual function, one-third indicating that this had improved after hysterectomy, while 3% reported a deterioration.

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Why do we have a biological clock? It has been suggested that, during the course of evolution, organisms have maximized their use of the environment so as to maximize their chances of survival. It has been shown that man’s efficiency varies during the 24 hour period. We perform best between 7 a.m. and 11 a.m. in the morning, and worst at 3 a.m. at night when most of us are sleeping. Hence, for man, sleep coincides with the time of lowest efficiency, which is at night. A phase map can be constructed for each bodily process within the 24 hour period. The phase map for body temperature shows that temperature is highest in the day and lowest at night. It has been suggested that the phase map of sleep coincides with the reduction of body temperature at night Dr Charles Czeisler of the Harvard Medical School claims that he can shift a person’s circadian rhythm quickly by exposing them to strong light and thus resetting the body block.

What about a natural body clock? Do we have one that is not under the influence of the sun? In one experiment, conducted in 1972, a French cave explorer, Michel Siffre, lived underground in a Texas cave for seven months, away from all noises and civilization. He was not permitted to have any watches, clocks, radios, or televisions. In other words, his external cues for time were removed completely. Under these experimental conditions, without an external time cue, the body clock was free running. After a period of days the natural body clock would emerge. It was found that under free running conditions the human body clock was about 25 hours.

However, once he returned to the natural environment, the body clock was reset to 24 hours again. This resetting of the biological dock depends on external cues, the strongest being the change from dark to light.

Experiments have also shown that if we are placed in an artificially lit day of 19 hours and an artificially dark night of 9 hours, we can be trained to live in a 28 hour clock. In this case the biological clock gradually becomes a 28 hour clock instead of a 24 hour clock, and the phase map of temperature shows a maximum once every 28 hours instead of once every 24.

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