‘I never heard of this disease until a few months ago. It was confirmed by the sixth doctor I went to and I wish I’d seen him before Jack, my fianc?, took off Jack was pretty fed up with me and my condition and all our trips to emergency rooms, occasionally in the middle of the night. I would double over with pain and sometime could barely breathe.

“Jade said he loved me and that he’d do anything to help, but he didn’t exactly love what he’d been hearing from the doctors: that my pain was from V.D.! It’s humiliating to be told by three different doctors on three different occasions over eight months that your symptoms—most of all your pain—add up to an advanced stage of venereal disease. Especially when you’re clean! Two other doctors treated me for a bladder disorder, vaginal infections, and once for a spastic colon. I had the reeling that they were wrong and that it was something deeper, more serious, but I didn’t know why I felt that. It scared me.

‘I was living on sulfa drugs, antibiotics, and assorted painkillers. The severest pain lasted about three or four days. Then I’d feel achy, and then okay for a while. I heard from a friend that orgasm relieved pelvic tension, so I’d try to be more sexually active. The irony was char intercourse hurt, leaving both Jack and me frustrated and angry. Jack was beginning to accuse me of faking the pain and cheating on him. It was die last test, the one for chlamydia, chat did it tor Jack. His sympathy had been strained to the limit and he left me. The pain increased in frequency and duration.

“About six months ago, I was telling a friend and her sister about the problem and I got an answer. My friend’s sister was a sufferer, too. She’d been through ten yean of misery and suffered the loss of an ovary, and she still had some problems. She said she felt as if she were reliving her own history by listening to me. When I heard about endometriosis tor the first time, the pain made sense. I finally felt I had a chance.”

It’s always sad to hear such stories of women who don’t get any emotional support or effective medical care for long periods of time. Not once was Alexa’s pain taken seriously. This is the real crisis in diagnosing endometriosis. What is the problem?

*15\43\4*

Although no two women are alike, similarities often emerge which include the need to correct biochemical imbalances, assist in the elimination of toxic waste and treating the inherited miasm.

We asked a herbalist to answer the following questions.

What is miasm

A miasm is the term alternative therapists give to a genetic weakness which is the foundation of a chronic disease. Samuel Hahnemann, the founder of homeopathy, considered there to be three basic miasms (taints): psoric, sycotic and syphilitic (having their ancient origins from leprosy, gonorrhoea and syphilis respectively.)

There is also a tubercular taint which is a mixture of psoric and syphilitic. From a homoeopathic view, these miasms have the potential to express themselves in various symptoms which are particular to the taint and each miasm can show an identifying pattern in the iris.

The herbalist explained that from a homoeopathic point of view, there are three main inherited factors which are the miasms discussed above. She said that someone back in the family tree may have had one of four things: tuberculosis, psoric, gonorrhoea or syphilis. Generations ago, these illnesses were treated with suppressive methods or left unresolved and there will still be a modified form of the disease present in the family tree today.

This doesn’t mean that you are going to inherit these diseases, but you will have a potential towards certain complaints. For instance, the gonorrhoeal (sycotic) taint bequeaths a tendency to pelvic discharges, inflammations and adhesions.

The inherited taint itself will initially be dealt with by herbs but finally with homoeopathies of a very high potency.

Homoeopathies are also used for treating thrush, bladder pain or infection, infertility, hormonal imbalance, Candida, imbalances in blood sugar levels, pain or other problems needing a specific focus.

She believes that in women with endometriosis the immune mechanism is possibly altered in a way which allows the implantation of tissue outside the normal area. Such an internal environment allows the hereditary weakness (defective immune mechanism) to come to the surface. Her theory is that it also might be likely that many women have retrograde bleeding at some stage of their menstruating life without consolidating it into a long-standing problem.

What type of woman do you see

As far as I am concerned there are three different types: many are post-endometriosis in as much as they have had surgery and are still unwell; there are those who have been diagnosed with endometriosis and who are either dissatisfied with the treatment or who want to investigate further before making a decision about what they should do — hormone therapy, surgery, get pregnant or whatever; then there are those who have a vague suspicion they have endometriosis but have been told they were either imagining it or needed a holiday and consequently have decided to investigate further.

What are the main symptoms

There are 101 different symptoms you can put under the endometriosis umbrella. Most common is pain.

Some women complain of pain and feeling bad, usually for the two weeks preceding menstruation. Other common symptoms include fatigue, bloating, irregular and abnormal bleeding, rectal bleeding, pain in cycle, pain in bowel, pain in bladder, a general feeling of pressure within the pelvic cavity, painful intercourse, infertility, depression, lethargy insomnia, diarrhoea — sometimes alternating between constipation and diarrhoea — and a general feeling of being ‘nervy’.

Other symptoms include blood pressure changes, leg cramps, palpitations, changes in body temperature, mood swings, changes in weight — most often an increase although some people seem to lose a lot of weight — skin rashes, flushing, loss of libido and sugar cravings.

Other associated symptoms include some tendency towards showing a hormone imbalance.

What happens at the first visit

An hour is allowed for each consultation — possibly longer for the first. A detailed list of symptoms is taken, together with answers to relevant questions detailing such things as sleep patterns, moods, traumas etc. This can take some time as the woman has the opportunity to ‘divulge all’, and there is usually quite a deal of bottled-up anguish in endometriosis cases.

A medical history is taken — past illnesses, operations, traumas, etc. A list is made of past and current medications and a family medical history is taken. An inspection is made of the woman’s hands, nails, hair, tongue, palpation over liver/stomach/ spleen/ovaries/kidney area, examination of any rashes, moles, lumps, etc.

After I arrive at any treatment programme, I discuss this with the woman, explaining the method and significance of the remedies and the anticipated healing path ahead.

What is your treatment regime

Bach flower essences: For the mental/emotional sphere — to help emotional blocks and negative beliefs.

Diet: Non-chemical foods. An emphasis on low fat, high fibre, low sugar foods. No processed or refined foods. Ideally, organically grown fruit, vegetables, cereals and grains, filtered water. Avoid coffee, tea and alcohol. If Candida is present, a special anti-candida diet will be prescribed.

Pain management: If needed, acupuncture and visualisation may be considered.

Stress management: Meditation, yoga, massage.

Exercise: Gentle, regular exercise such as walking, cycling, swimming. No jarring exercise such as jogging.

Usual length of a treatment cycle

Two to 18 months, most around the six to eight month span with intermittent visits over the longer period. It is sometimes hard to tell due to lack of compliance to treatment — after the pain has gone, the motivation to complete the healing programme can disappear.

Women being treated usually require a visit once every four weeks.

Diagnosing problem areas

Generally speaking, many women I see do get many of the symptoms reported here. I use iris diagnosis. I find it extremely helpful in cases such as endometriosis. If I suspect there might be irritable bowel syndrome, iris diagnosis will show that and will also show me where the inflammation is.

Most endometriosis sufferers have inflammation around the fallopian tubes, ovaries, bowel and in the pelvic area generally. I believe it can also be transported to the breast and the lungs.

Cost of a consultation

A consultation costs $33 ($28 concession). Remedies depends on those chosen but generally average out to approximately another $30 to $35.

Why is the lymphatic system so important

The lymphatic system manufactures white blood cells to create antibodies to fight infection. Every day the lymphatic system takes nutrients and oxygen to every cell in the body and removes wastes. When the lymphatic system is congested, you start to feel unwell and tend to get tired quickly. It is important at that stage in the treatment to clean up the lymphatic system. A clogged lymphatic system creates an ideal situation for the development of tumours and cancers.

Do most women with endometriosis also have Candida albicans

Some symptoms of endometriosis could also come under the heading of Candida albicans. The reason that I list Candida albicans amongst my questions is because I do believe it and endometriosis often go together. If I suspect Candida is present — once again the iris is great for showing that — I treat it first. Once the Candida goes, so does the intolerance to many foods. Candida can really give a distorted picture.

Herbs or tinctures/extracts usually prescribed

Herbs are beneficial in helping with pain. Normally your herbalist will prescribe ‘tinctures’ which are solutions of herbs — usually not very pleasant tasting but effective.

Depending on your symptoms — severity of pain, digestive problems, infertility, heavy bleeding, inflammation, headaches — die herbalist will blend together a bottle of herbal solution that often looks like murky dishwater — and quite often smells like it! You will be advised as to how often and when this tincture should be taken. All are administered orally, either as a few drops on to the tongue or mixed with a little warm water.

Many endometriosis sufferers report good results using herbal remedies for the treatment of pain, tiredness, depression, irritability, lethargy, headaches and many digestive problems.

Probably one of the most difficult things after an inspiring visit to a naturopath or herbalist is to arrive home with an armful of vitamins and a combination of herbs. Apart from being expensive, you have to train yourself to remember to take them daily. But many women certainly find the effort worthwhile. Many endometriosis sufferers have reported the benefits of vitamins in helping to reduce tiredness, pain, lethargy and depression.

But don’t expect immediate miracles. You will not be cured overnight — be prepared to wait for three months before noticing any change in your condition.

*85\83\2*

Adenomyosis is a condition in which the endometrium lining the uterus penetrates and grows into the adjacent muscle layer of the uterus. How the endometrium invades the muscle wall is not clear.

Adenomyosis is most commonly found in women in their 40s and 50s who have had children.

The main symptoms of adenomyosis are heavy bleeding and painful periods. It is thought that about 25% of women with adenomyosis have no symptoms at all.

The severity of the bleeding is related to the extent of the condition and in some women the bleeding is so excessive that the woman is actually haemorrhaging.

The severity of the pain appears to be related to how far the endometrium has penetrated into the muscle wall and some women may experience severe and incapacitating pain during menstruation.

A doctor may suspect that a woman has adenomyosis from her symptoms and an examination will usually indicate a moderately enlarged uterus. A definite diagnosis is difficult and is often only made when the uterus has been examined following a hysterectomy.

The drugs used for the treatment of endometriosis are not effective in the treatment of adenomyosis and for many women the only treatment for adenomyosis is hysterectomy.

*25\83\2*

Essential fats

Unfortunately fat has got itself a bad name, although it’s actually only saturated fats that are harmful. Many women now consciously avoid all fats as a matter of course. But there are some fats which are vital for your health – and your fertility.

These are called essential fatty acids and they are found in foods such as nuts seeds and oily fish. These essential fats are a vital component of every human cell and the body needs them to balance hormones, insulate nerve cells, keep the skin and arteries supple, and keep itself warm.

Unsaturated fats can be divided into monounsaturated and polyunsaturated fats. Monounsaturated fats are not classed as essential fatty acids. Olive oil is high in these monounsaturated fats, which are thought to lower the risks of heart attacks and other circulatory problems.

Polyunsaturated fats can be split into Omega 3 oils (found in unrefined safflower, corn, sesame and sunflower oils) and Omega 6 oils (found in fish oils and linseed or flax oil). The body makes beneficial prostaglandins (hormone-like regulating substances) from Omega 3 oils, so that is why they are particularly useful for increasing fertility.

If you are not getting enough of these essential fatty acids, you may notice symptoms such as:

• Dry skin

• Cracked skin on heels or fingertips

• Hair falling out

• Poor wound healing

• Dry, difficult hair

• Dandruff

• Irritability

• Soft or brittle nails

• Allergies

• Fatigue

• Hyperactivity

• Difficulty losing weight

• High blood pressure

• Arthritis

• Pre-menstrual syndrome

• Painful breasts

If you have several of the above symptoms they may also be due to thyroid imbalance which can also affect your fertility, so it is worth checking with your doctor.

To achieve a satisfactory intake of essential fatty acids, have a daily handful of nuts or use a salad dressing made with a good-quality nut or seed oil. You can also eat oily fish (such as mackerel or sardines) and take an essential fatty acid supplement.

*24/73/5*

There are four stages of syphilis infection: primary, secondary, latent and tertiary. Symptoms of primary syphilis start between 9 and 90 days after infection. An ulcer, called a chancre, develops at the place where the infection got in. Typically this is a shallow ulcer with a raised edge and a firm base, and is usually painless and solitary, but there can be several chancres. It can be so small that you don’t notice it, or very large. The nearby lymph glands usually swell but aren’t tender.

The chancre is usually on or near the genitals but can be around the anus, mouth or anywhere that’s been in contact with a partner’s chancre. In women the chancre may be inside the vagina or on the cervix where it can’t be seen. During the primary stage of syphilis you don’t usually feel ill, so if the chancre isn’t noticed or can’t be seen you may not know you’ve been infected. The fluid that oozes from the ulcer is highly infectious.

If primary syphilis isn’t treated, the chancre heals within a few months and the infection proceeds to the secondary stage. The symptoms of secondary syphilis appear when the infection has been spread throughout the body by the blood, which takes between one and six months after the beginning of the primary stage. It begins like ‘flu with fever, sore throat, headache, loss of appetite, aching muscles and generally feeling unwell. The ulcer may reappear at its first site and others may break out in and around the genitals and mouth. Lymph glands throughout the body swell; you may notice them in the armpits, groin and neck. Wart-like lumps can develop on the genital and other skin, and your hair may start falling out. There is usually a rash that affects many lining membranes and the skin, including the palms and soles (most rashes don’t appear on these parts). Parts of the rash may break down to form very infectious ulcers.

This sounds terrible and it is: if secondary syphilis isn’t discovered and treated the symptoms can continue on and off for a year. This is the most infectious stage of the disease, and even after the symptoms have settled down you remain infectious for the following year during the next (latent) stage.

During the latent stage, which can last for the rest of your life, the infection is hidden because you have no symptoms.

However, if you’ve had no treatment the spirochaetes can be slowly causing inflammatory damage throughout the body that leads to the symptoms of tertiary syphilis.

Tertiary syphilis can affect almost any tissue or system in the body. The nervous system, heart and blood vessels, bones, skin, vision, hearing and many internal organs are at risk of severe damage from the chronic inflammation the spirochaete can cause. The symptoms depend on how much and which part is affected. They often mimic the symptoms of other diseases: tertiary syphilis used to be called ‘the great imitator’. More than two-thirds of people with latent syphilis don’t progress to tertiary syphilis.

*316/31/5*

Many people, especially women, haven’t learnt good bladder control in childhood and have what we call a ‘weak’, overactive or unstable bladder, in which all the mechanisms for holding a reasonable amount of urine are disturbed. Their lives become dominated by frequency, urgency and urge incontinence.

When the bladder is oversensitive to stretch, it contracts inappropriately while it’s filling or in response to other stimuli such as hearing a running tap, feeling cold or changing posture. It tells you that you must urinate long before it is filled to capacity. The unstable bladder contracts, as if to empty, without your permission. The contraction leads to a powerful, knee-crossing, eye-watering, urgent desire to urinate. This sense of urgency can’t be suppressed easily, and might eventually progress to become urge incontinence.

Treatment of unstable bladder

The most successful approach to an unstable bladder and urge incontinence is through bladder-retraining programmes, which teach your bladder to hold more before registering the urge to urinate, and how to control the urge when you feel it. These programmes are taught in bladder-control clinics or you can try teaching yourself from a self-help book or Continence Foundation Fact Sheet. However, it’s generally best to have all incontinence problems assessed by a specialist urologist to ensure that you have no chronic urinary infection or other condition that needs different treatment, and to advise you about suitable exercises.

One important part of bladder retraining is increasing your daily fluid intake to around 2 liters. Most women with urinary control problems are in the habit of limiting fluid intake to fit in with their plans. If you’re going to the theatre in the evening, you make a point of drinking nothing after lunch so that you won’t have to wait in the loo queue at interval (though you do, ‘just in case’) or, worse still, go in the middle of Act One.

The point of increasing fluid intake is to allow you to experience the feeling of true bladder fullness. Once your bladder has had the opportunity to be really full several times a day it will stop sending out bursting messages when it contains (dare I say) piddling amounts. One woman who’d successfully retrained her unstable bladder told me ‘Until now I’ve missed out on the great joy of weeing when my bladder’s really full’.

Bladder retraining needs willingness to persevere and determination to succeed. (It also needs strong pelvic-floor muscles, so get them in good shape with pelvic-floor exercises before you start.) It can take several months to achieve the full benefit, though you’ll be encouraged by the considerable improvement you notice after the first couple of weeks. In some cases the use of drugs to relax the bladder will help with retraining. Some people are helped by biofeedback techniques and acupuncture.

Surgical repair is not often used to treat urge incontinence, unless there is also stress incontinence resulting from damage that is too severe to respond to pelvic-floor exercises. Surgery for any type of incontinence should be on the advice of a specialist urologist, and after a urodynamic test to investigate the problem.

Such fistulas, however, are uncommon.

Incontinence caused by permanent damage to the nervous system such as multiple sclerosis, stroke or spinal injury cannot be cured, but special management plans and newly available drags can do much to improve the lot of sufferers. Recently there have been reports of success with some such cases of incontinence when artificial sphincters have been used,

It is important that in every case of incontinence, proper testing is carried out to diagnose the exact cause(s) and to look for any additional problems such as urinary infection or chronic bladder inflammation. Successful treatment depends on a precise understanding of the cause.

The Continence Foundation of Australia will tell you where to find special clinics for the diagnosis and treatment of incontinence. If you think you would benefit from attending a clinic, ask your doctor for a referral. I’m sure you will find that any travelling that may be necessary is well worthwhile.

Community services

The Continence Foundation of Australia (59 Victoria Parade, Collingwood, Vic. 3006. Tel. (03) 9416 0857) provides information about services available throughout Australia, pamphlets, self-help fact sheets including instructions for pelvic-floor exercises and bladder retraining, educational programmes for health workers and the public, and a quarterly newsletter.

*287/31/5*

I
had been trying for three years to get pregnant. No
luck. It was getting me down, so I
finally went to Adelaide to see a specialist. The doctor didn’t find a cause when he examined me. He suggested that because I live so jar away, I should have as many tests as possible while I was in town, including a laparoscopy, which meant staying in hospital overnight. Soon after I woke from the anaesthetic the doctor came to see me and told me he had found endometriosis. He said he was surprised that I hadn’t had pain with periods or sex. I
had, sometimes, but nothing to complain about.

I was prescribed tablets to take for six months, and asked to go back when I’d finished the course. I’ve been on them for five weeks. My face has broken out and I haven’t had a period, but a sheet of instructions with the tablets said to expect side-effects.

I’ve never heard of endometriosis before. My doctor tried to tell me something about it, but I was too groggy from the anaesthetic to remember much or ask any questions. I
had to leave for home the next morning, so I
didn’t have a chance to find out any more. I
rang the nearest library but the book sent to me was no help. I want more information so that I can have my questions ready for my next visit to the doctor.

I hope the following information will help women with endometriosis to understand more fully their condition.

In endometriosis (‘osis’ means ‘а condition of) spots of tissue identical the endometrium grow outside the uterus. They are called endometrial deposits or implants, and may occur on the ovaries (the most common place), tubes, in the muscle or on the outer covering of the uterus and on the membrane lining the pelvic cavity. They are occasionally found on the outside wall of the bowel. The endometrial deposits range in size fro spots that can only be seen under microscope up to a centimeter or more in diameter.

Endometrial deposits are influenced the same hormones that control the growth of the endometrium in each menstrual cycle. Endometriosis tissue dies and bleeds at the time of each period but fluid can’t drain away. It irritates other tissues and organs that it touches, causing the formation of fibrous tissue that sticks the parts together (adhesions). With time this tissue contracts, distorting the shape and disturbing the function of the parts. In severe, longstanding endometriosis the pelvic organs and part of the bowel may become bound together into a solid mass.

The surface of most endometrial deposits also becomes covered by a capsule of fibrous tissue. The fluid and blood then collects underneath to form cysts, which become slightly bigger with each menstrual cycle. These cysts are also known as endometriomas or ‘chocolate cysts’. Some of the watery constituent of the fluid in the cysts is absorbed and the blood darkens, leaving a thick, viscous fluid like melted chocolate – hence the name. Cysts usually remain less than a centimeter in diameter (mostly pinhead-size) but may grow up to 3 cm, rarely 10 cm or more.

Endometriosis is not cancerous or life-threatening (though rarely, the pressure inside a cyst may increase to the point where the wall ruptures, creating an abdominal emergency). But it can cause so many problems that it has been described as ‘the thorn within’.

*258/31/5*

Psychotherapy

Many women who suffer mainly psychological symptoms premenstrually are generally depressed and may benefit from psychotherapy and in some cases antidepressant medication.

Exercise

I have mentioned that disturbance of hypothalamic endorphins has been suggested as a factor in the cause of PMS. Endorphins are believed to be important in maintaining harmony of the mind and body. We produce extra endorphins during aerobic exercise – the kind that brings you out in a good sweat – and they’re thought to be responsible for the feeling of elation after a session at the gym and with jogger’s high’. It’s been suggested that regular aerobic exercise might reduce or even eliminate some of the symptoms of PMS. It’s worth a try. While more research is being carried out, why not conduct your own personal study.

Sedatives and tranquillizers

These are believed to be of no value in the treatment of PMS, and shouldn’t be used unless there are other reasons to do so.

Vitamins

Many of the vitamins have been used to treat PMS. Their use is largely empirical (meaning that we can’t explain why they should work). Some women find that mood changes are relieved by vitamin B6 (pyridoxine) used in dosage of 25 mg four times a day. However, studies of large numbers of women have found that only about 50 per cent improve -about the same rate as placebo. Remember that you can overdose on B6 – don’t take more than 100 mg per day.

Vitamin Bl (thiamine, 50 mg morning and night) relieves breast symptoms in about half the women who try it. Other vitamins that have been enthusiastically recommended are large doses of vitamin С (1000 mg or more per day, which in the long term can cause toxic side-effects), vitamin E and vitamin B12. None of these has produced better results than placebo.

Minerals

Large doses of various minerals have been recommended. Magnesium, zinc, potassium, calcium and manganese all have their supporters, though there’s no known reason or evidence to support their use. A balanced diet provides all the minerals we need, and supplements are unnecessary unless a specific deficiency is proved.

Diet

Many special diets have been recommended for relief of PMS. They’re usually heavy on the ‘don’ts’. Among the foods that have been suggested as culprits are red meat, dairy products, sugar, salt and those that contain caffeine. None of these diets have been properly evaluated,

but some women report improvement breast symptoms after cutting down on caffeine and less fluid retention after reducing salt intake.

Miscellaneous therapies

And those that have been tried are acupuncture, yoga, meditation, massage, various herbal and homeopathic remedies, therapy and colour therapy. None of these have been properly evaluated for effectiveness, but most have the benefit of enhancing health awareness, reducing and promoting physical and emotional well-being so they should help to relieve PMS.

The politics of PMS

In recent years PMS has become a controversial feminist issue. Many women applaud the fact that PMS has at last been recognised and accepted as having genuine adverse effects on women’s health and behaviour. Others feel that this recognition represents a backward step for equal opportunity for women: that it adds to arguments used to exclude women from positions of responsibility.

Whichever of these views you hold and
whatever has been your own experience, I’m sure that you’ll agree that women suffer from PMS need sympathy and help. Though it’s no longer regarded as ‘all in the head’, the syndrome’s cause remains a mystery and until that’s solved there’ll be no reliable, effective prevention or treatment. Research must continue.

*229/31/5*

Oestrogen is given
in the form of oral tablets, vaginal creams, pessaries or hormone-releasing rings, skin patches, or pellets implanted under the skin. Progestogens can be given by mouth. Combinations of both hormones are available as tablets, skin patches and intravaginal rings. Your doctor will discuss the methods of treatment with you, and advise you which type to try and how to use it.

You’ll hear a lot about ‘natural’ and ‘synthetic’ hormones. No naturally occurring human oestrogens are used for HRT. Some are obtained from mares and the remainder are manufactured. Some of manufactured oestrogens are basically same as those produced by the human ovary. Others, called synthetic oestrogens, are chemically slightly different from any naturally occurring oestrogens, but close enough to attach to oestrogen receptors and produce the same effects in cells. At present it is thought that synthetic oestrogens may have potential for more side-effects than natural oestrogens.

HRT needs to be individualized. All the oestrogens have similar effects, so it doesn’t matter much which is used, but different women need different doses. There’s more variation in how women respond to progestogens and no reliable way of predicting which will be most suitable. Some women need to try several to see which suits them best. Your doctor will suggest a visit within two to three months of starting treatment to see how you’re going and make any necessary adjustments.

Note the following points.

• It can take two to three weeks before you feel the full benefit of HRT. If after three weeks you’re still having some flushes, see your doctor: you may need a higher dose.

• It’s generally less expensive in the long ran (especially if you have broad-cover health insurance) to buy larger quantities of hormone tablets than those available on the Pharmaceutical Benefits Scheme. It may also be cheaper to buy larger-dose tablets and divide them: some are scored in halves or quarters to make this easier. Discuss treatment costs with your doctor.

How long should HRT be continued? This question can’t be answered confidently yet. Some doctors prefer to replace hormones only for as long as they’re needed to relieve symptoms like hot flushes. If you’re taking HRT to prevent the risk of fractures from osteoporosis and other long-term health problems resulting from a lack of oestrogen, it is necessary to continue treatment indefinitely. Studies are proceeding on women who choose to continue treatment into old age, but it will be at least another 10 years before results can be analyzed.

Non-hormonal relief for menopausal symptoms

There is no doubt that oestrogen replacement provides the most effective treatment of menopausal symptoms. However, if you can’t or don’t want to use oestrogen, the following measures may help relieve hot flushes and other symptoms.

• Avoid things that you know trigger hot flushes such as those mentioned.

• Reducing caffeine intake (coffee, tea, cola drinks, chocolate) may help with flushes, insomnia and palpitations.

• Many women are helped by body-mind exercises such as yoga, T’ai chi, meditation, massage and relaxation techniques.

• Some women get relief from alternative health therapies such as herbal or homeopathic remedies, hypnotherapy, acupuncture, naturopathy.

• If you regularly take other medicines, ask your doctor whether they may be aggravating menopausal symptoms.

• If you can’t use HRT by mouth, implants or skin patches, vaginal oestrogens may be suitable for relieving a dry vagina and vulva itch.

• Look after your general health.

*200/31/5*

Routine checkups in an uncomplicated pregnancy are usually done every 4-6 weeks until 28 weeks, then every 2-3 weeks until 36 weeks, and then every week until the baby is born. If there are problems, checkups will be more frequent. If anything worrying happens between appointments, don’t wait: contact your doctor or hospital straight away.

During a routine checkup, you’ll be asked how things have been going since your last visit. Your blood pressure and weight will be measured, and a urine sample tested. Your abdomen will be examined to check the size of your uterus and, after around 26-8 weeks, the position and heartbeat of the foetus.

If any problems are suspected from these quick and simple checks, other tests may be needed for more accurate diagnosis. Early treatment of many problems may prevent more serious complications. These problems include:

• high blood pressure (pregnancy-induced hypertension). This rarely develops before 28 weeks and is most common after 34 weeks and in first pregnancies. If hypertension isn’t controlled, it can lead to eclampsia or antepartum haemorrhage

• uterus larger than expected. This finding prompts ultrasound examination to find the cause, which is most commonly that the pregnancy is more advanced than the dates suggest; occasionally multiple pregnancy

• uterus small for dates. This suggests that the foetus isn’t growing at the normal rate. Ultrasound is used to find out why

• unusual position of the foetus. It is important to know if the foetus isn’t in the usual head-down position when delivery is close. Fortunately, many foetuses in breech or transverse positions turn to head down before labour commences.

If any problems arise during pregnancy, you and your partner will be given every opportunity to discuss possible causes and consequences, and the available treatment options.

*163/31/5*