The Health Blog

Julie’s story

I am one of the few people who suffered virtually no symptoms of endometriosis. It was discovered when a laparoscopy was performed because I had an infertility problem. I have been married for two and a half years and a slight hormonal imbalance was found to be a contributing factor to my problem. We were trying for our first child.

I was put on a course of Danazol — three times per day for six months. But I didn’t just take it straight away

The gynaecologist told me in hospital that he was giving me a tablet that I would take for six months. As he was at the door I called out to him ‘Any side effects?’ and he answered ‘Weight gain and a few pimples’. Then he was gone.

Two weeks later I received a prescription in the mail. I assumed that I was supposed to just go to the chemist, get the pills and start taking them. But I didn’t. I wasn’t going on to any hormone drug therapy until I was satisfied that it was perfect safe for me. I have several reasons that make me a special case, including a breast lump removed and diagnosed as ‘pre-cancerous’.

For the next three months I asked anyone who might know about Danazol and its effects. I considered alternative treatments such as Chinese herbal medicine. I was looking for anything that might stop me taking Danazol!

I was scared! I read all the information sent from the Endometriosis Association. The list of side effects and percentage of people to experience them looked terrible!

How much weight do you gain? How much hair do you get on your face? Does your voice go really deep? Will I start ovulating again when I come off Danazol? Does Danazol really cure endometriosis? The list goes on.

Finally, after a few chats with my GP and the Association (who were both extremely helpful), I decided to wait three months. My circumstances had changed and we thought that if I were more relaxed I might conceive anyway.

No luck. So I went on the Danazol. After three weeks I noticed a decrease in breast development. I started getting frequent muscle cramps — all over. My voice started to get a little hoarse — only after talking for a while and certainly not all day every day. After five to six weeks my skin started to get oily and pimply. My weight steadily increased — by 21 weeks I had gained at least eight kilograms. But I was underweight to start and now everyone tells me I look better. Most of this weight is due to my extraordinary muscular broad shoulders — another side effect.

I have four weeks and two days to go. The worst side effect I have had would be the oily skin and acne.

My message is this. Find out all you can about the treatment and side effects and decide on how you will cope. Don’t be scared off by figures and long lists that you read or hear about. Talk to as many people as possible. The side effects are really not bad at all — and not as severe as you may think. For example, you won’t get so much hair on your face that you have to shave! Most people will not notice any change in you at all.

Lisa’s story

I am a professional entertainer. As a teenager, my periods had never been of concern to me. However, at the age of 29 I developed severe period pain and heavy bleeding and found it impossible to continue performing for the first two days of my period.

I consulted my GP who was surprised I was having days off work due to period pain, so immediately referred me to a gynaecologist. After listening to my symptoms he asked me a few questions. He asked if I had pain on intercourse. I finally conceded that I did, but only at certain times during the month. He asked if I suffered from backache. I answered that I did but I had put it down to my long hours of stage entertaining. He wanted to know if I had any bowel problem. I admitted that I sometimes had bouts of pain and diarrhoea but I put that down to my irregular eating habits.

After considering all my answers the gynaecologist said he drought I had endometriosis and that he wanted to perform a laparoscopy the following week.

After the laparoscopy I was shocked when I was told I had severe endometriosis and two options were to take Danazol or have a baby. I told him I did not want to have a baby, then or in the future. He said to think carefully about having a baby because it might be one way of curing die disease.

I asked him about the other option, Danazol. He was frank with me and told me the side effects that I might develop. Then the bombshell hit — he informed me that there was a remote chance that the Danazol could cause an irreversible deepening of my voice.

I didn’t want to believe what I was hearing. First, I was told to get pregnant but I didn’t want a baby. Second, I was told to take a drug that could ruin my career. I didn’t know what to do or where to turn.

My gynaecologist realised how upset I was and suggested I could try another drug called Duphaston. He told me that it was a synthetic progesterone and therefore didn’t have the same side effects as Danazol. I was willing to try this drug. I was to take 30 milligrams of Duphaston daily for nine months.

I have just completed the course of Duphaston and I can honestly say I feel a lot better. I had a few side effects whilst taking Duphaston but nothing I couldn’t accept. I had tender breasts and nausea in the morning. I continued to menstruate but the pain subsided after two months and my periods weren’t nearly so heavy.

I am now looking forward to once again putting all my energies into my career in entertainment.

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The female reproductive organs consist of the uterus, fallopian, tubes, ovaries, cervix, vagina, vulva, clitoris and labia.

The cervix is the lowest part of the uterus and is about the size and shape of a small plum. It contains a small canal which connects the uterus and die vagina.

Vagina-The vagina is a thin elastic tube approximately 7.5 centimetres in length which extends from the vulva to the cervix.

Vulva-The vulva is made up of the clitoris, the external opening of the vagina and the labia.

Clitoris-The clitoris is a small organ of erectile tissue which is found at the upper end of the vulva.

Labia-The labia are the two folds of tissue which surround the entrance to the vagina.

Other related structures:

Pelvic cavity-The pelvic cavity is the space within the pelvic bone which contains the reproductive organs, the bladder and the lower part of the bowel.

Peritoneum-The peritoneum is a thin layer of clingfilm-like tissue that covers the organs within the pelvic cavity and the inside of the pelvis.

Peritoneal fluid-The peritoneal fluid is the lubricating fluid which is secreted by the peritoneum to keep the surface of the internal organs moist.

Pouch of Douglas-The Pouch of Douglas is the pocket-like space, lined by peritoneum, which lies between the back of the uterus and the front of the lower bowel.

Ligaments-Ligaments are bands or cords of strong tissue which hold parts of the body in place.

The uterus is held in place by four pairs of ligaments: the utero-sacral ligaments, the round ligaments, the broad ligaments and the transverse cervical ligaments. The pair most commonly affected by endometriosis are the utero-sacral ligaments which extend from the lower part of the uterus and pass either side of the lower bowel, ending at the tail bone.

The recto-vaginal septum is a ligament which lies below the Pouch of Douglas and extends between the vagina and the rectum.

Pituitary gland-The pituitary gland is a small gland about the size of a pea which lies just below the brain. It releases a variety of hormones which are important for the control of many of the body’s functions, including the menstrual cycle.

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No one knows precisely but there are several factors known to be implicated.

•     Hormonal changes are a crucial feature of the menstrual cycle in all women. In the first two weeks of the cycle (i.e. the first two weeks after the start of a period) there is a substantial level of the hormone oestrogen and in the second two weeks the level of another reproductive hormone, progesterone, rises. These sex hormones affect not only a woman’s sex organs and her breasts but every organ of her body and an imbalance can produce a wide range of symptoms. Many experts now believe that low levels of progesterone are to blame for most, if not all, of the symptoms seen in PMT. Women with PMT have relatively lower levels of this hormone than do non-sufferers. It is the balance between oestrogen and progesterone in the blood that seems to be crucial. Oestrogen can antagonize progesterone so that even if you produce enough progesterone it can be wiped out by too much oestrogen. Normally progesterone acts as a natural diuretic, clearing fluid from the body. If a woman’s progesterone levels are low she accumulates salt and water, feels bloated, has joint pains, gains weight, feels tense, gets tired easily and can even have visual disturbances. A few women become so bloated, that they are unable to wear their contact lenses.

But the most important action of progesterone in this context is on sugar metabolism. Without enough progesterone the body is unable to deal with sugar properly and the result is hypoglycemia. It is this that produces so many of the mental symptoms seen in PMT. Hypo-glycaemic signs include headaches, migraines, fainting, weakness, irritability, aggressiveness and panic attacks. Once menstruation begins, sugar metabolism returns to normal and the woman feels well again. Alcohol and caffeine can also play havoc with blood-sugar levels and are best avoided pre-menstrually.

•     Childbirth seems to increase the chances of suffering from PMT. The more babies a woman bears (especially if she has toxaemia) the more likely she is to suffer from PMT.

•     Age. PMT generally increases with age. Women in their thirties seem to suffer most.

•     Stress. This definitely seems to make PMT worse and even to precipitate it. Married women complain of more severe PMT than do single women, which may be accounted for by marital stress.

•     Lack of physical activity seems to play a part too.

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How do you catch herpes?

Herpes is caught by direct contact with another person’s lesion or sometimes in the early stages of an attack before the lesion has broken out. The viruses penetrate moist membranes such as those of the mouth, genitals, rectum or eye, through a break that may be too small to be noticed.

Because kissing and sexual intercourse are the most common close encounters we have with others (and also likely to cause small breaks in membranes or skin), the mouth and genitals are the most common sites of infection by these viruses. Infection can also be transferred if a hand that is contaminated from an infectious part immediately touches broken skin or a moist membrane. This is probably how the viruses spread when oral herpes sweeps through a class of small school children, or when the eye becomes infected.

A baby may be infected during birth if the mother has genital herpes at the time or if there is contact with the virus (by kissing or from contaminated hands) in the early months of life.

Infected people occasionally have recurrences without any symptoms. We also know that three-quarters of people with genital herpes have never been diagnosed. These people commonly don’t recognize their (usually minor) symptoms. This explains how a first infection can occur when neither partner knows they are infected and neither has been unfaithful.

The first attack

After initial infection it usually takes between two days and two weeks (sometimes months or even years) for symptoms to appear. Once the herpes virus enters a cell, it takes over the cell and makes it manufacture more viruses, which are released to infect nearby cells. As the infection builds up, tingling or soreness might be noticed at the site of infection. As more infected cells are destroyed by the virus, small blisters form on top of a red, painful swelling. This is called the primary lesion. At this stage you may feel unwell with a mild fever, headache and aching muscles. Glands in the groin will usually be tender, and it may hurt or be difficult to pass urine.

After a couple of days the blisters will break and often merge to form one or more ulcers. Over one to three weeks the body’s defences begin to overcome the multiplying and spread of the virus at the primary site of infection. When this happens, the ulcer dries and forms a scab. When the scab drops off, the skin under it has healed.

The first attack of genital herpes can occasionally be very severe. The ulcer can spread to become quite large and cause a lot of pain of the vulva or anal area. It can hurt to sit down – you may prefer to stand. If the tissues around the opening of the urethra become swollen, it can be difficult or almost impossible to empty your bladder. The groin glands may hurt when you walk.

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We all have a dread of breast cancer. Our fears are based on the common perception that it’s a ‘bad’ cancer to get. This is because it has a reputation for spreading quickly and for recurring after treatment. The treatments are also feared: women have heard that breast surgery may be mutilating, and that non-surgical treatments may have unpleasant side-effects. The diagnosis of breast cancer has a profound emotional impact because of these fears and because it affects a part of the body intimately linked with a woman’s self-image and sexuality.

By the time we reach middle age, most of us will know at least one breast-cancer victim. This disease affects 7 per cent of Australian women – about one in fifteen -making it the most common form of cancer in women in our country.

What causes breast cancer?

We don’t know. A recent theory is that some women carry a gene that makes them more likely to develop breast cancer. This gene affects breast cells so that they respond differently to the hormones that our ovaries produce, eventually becoming cancerous.

Who is at risk?

Older women are at more risk than younger women. The mothers, sisters and daughters of women who developed breast cancer before their menopause or in both breasts are two to three times more likely to develop the disease than those with no family history. But more than eight out of ten women with breast cancer do not have a mother, sister or daughter with this disease.

Women who have had cancer in one breast are at increased risk of developing it in the other, but treatment with anti-oestrogen drugs has been shown recently to decrease this risk by 40 per cent in postmenopausal women.

Some factors may increase the risk slightly:

• having your first baby after the age of 30

• having no children

• late menopause (over the age of 55)

• obesity, which is linked with late menopause.

Here are some more facts about the risk.

• Bumps or injuries to the breast are not associated with an increased risk.

• Breast-feeding has no effect on the risk of breast cancer.

• Postmenopausal hormone replacement’ therapy has been associated with an in-1 creased risk when taken continuously’ for 10 years or more.

• The risk of breast cancer for women is 100 times greater than it is for men.

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The Pap smear – also called ’smear test’ or ‘Papanicolaou smear’ (after its inventor) – is a simple test in which some cells are wiped from the surface of the cervix and examined under the microscope. The test was first used in the 1920s to diagnose cancer of the cervix. It was soon clear that the smear could also show certain changes in cells that might precede the development of cancer. This led to the use of the smear as a screening test, so that women who might be at risk of later developing cervical cancer could be identified and treated, if necessary, to prevent it. It is thought that among women who are screened, 90 per cent of cervical cancers can be prevented. In countries where regular screening is encouraged, the death rate from cancer of the cervix is decreasing.

We don’t know what causes cervical cancer, but there seems to be an association with sexual behaviour. It is rare among women who have never had sex, and occurs most often in women who began intercourse at an early age and/or have had a number of sexual partners. But we are all potentially at risk, so smears are advised for all women from the age of 18 (or within two years of first sex, whichever] is later) until 70 years of age.

How is a Pap smear done?

Very easily. A speculum is inserted into the vagina to hold its walls apart so that the cervix can be seen. A specially shaped wooden or plastic spatula or a small brush is then wiped around the cervix. This doesn’t hurt: some women feel an unusual sensation while the smear is being taken, but many feel nothing. The cells collected are transferred to a glass slide, which is sprayed with or dipped in a solution to preserve the specimen. It takes about two minutes to prepare for and collect the smear, though it is usually done as part of a general gynaecological check, which takes longer.

How often should it be done?

If the first smear is normal, repeats are advised every two years. If any suspicious changes are found at any time, more frequent smears are advised until the abnormality disappears, with or without treatment.

Repair of prolapse

The basic aim of this procedure is to shorten the stretched ligaments that hold the uterus in the pelvis and repair damage to the tendons or muscles of the pelvic floor. If associated cystocoele and recto-coele need correction, stretched tissue in the vaginal wall may need to be removed. Slightly different procedures may be planned for almost every case, depending on the degree of prolapse and damage to the pelvic floor. Vaginal repair is an operation designed to treat minor degrees of cystocoele and prolapse. More extensive repairs are needed if there is severe uterine prolapse, and sometimes hysterectomy is necessary for a satisfactory result.

Surgery for incontinence

Various techniques are used to lift the bladder and to tighten the bladder sphincter and pelvic floor muscles.

Urodynamic studies confirming the cause of incontinence should be done before you agree to surgery; these ensure that you have the right operation. If surgery is advised, ask your surgeon to explain what will be done.

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Health problems that may be aggravated by pregnancy include diabetes, hypertension, chronic disorders of the heart, lungs or kidneys, and epilepsy.

Diabetes

The control of diabetes is much more difficult during pregnancy because hormones from the placenta counteract the effect of insulin. Increased doses of insulin are needed to keep the mother’s blood sugar within normal limits, and more frequent (sometimes weekly) antenatal checkups are needed to make sure the insulin dose is enough. If diabetes isn’t well controlled, some complications of pregnancy are more likely, including pregnancy-induced hypertension and hydramnios. The babies of diabetic women are often larger than normal, causing problems during labour and delivery. Delivery is usually advised around 37 weeks.

In the past there was a high rate of stillbirth to diabetic mothers. Now that there is better understanding of the effects of diabetes in pregnancy and how to control them, the stillbirth rate to diabetic mothers is only slightly higher than that to non-diabetic mothers.

Hypertension

The effects of high blood pressure that existed before pregnancy are similar to those of pregnancy-induced hypertension. Problems are unlikely if you’re already on medication to keep your blood pressure within normal limits, but you must be checked often in case dosage needs changing and so that the condition of the foetus can be monitored. Occasionally bed rest and early delivery must be advised.

Other illnesses

If you have any chronic illness and are planning pregnancy, it’s wise to consult your regular doctor and an obstetrician before you conceive so that you’ll be aware of the possible effects of your condition on pregnancy and vice versa.

Chronic disorders of the heart, lungs and kidneys may be aggravated by the increased demands on the body during pregnancy. If you have epilepsy, careful supervision is needed. It is usually important during pregnancy to continue any regular medication that you take for a preexisting illness. This is especially important with anticonvulsants in epilepsy. Your obstetrician will consult with your physician to see whether your medication needs changing, and antenatal checkups will need to be more frequent.

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When I was a child I thought ‘hygiene’ meant washing your hands before eating and after going to the toilet, but it’s much more than that. The dictionary defines hygiene as ‘the science of preserving health’. Today we have a better chance than ever before of preserving our health through national, community and personal efforts.

Public health

Commonwealth, State and local government health authorities put great effort into ensuring that every Australian has the chance to preserve health. The National Health and Medical Research Council, through its committees of experts, advises governments on health policy.

Government measures that help to place us among the world’s healthiest nations include:

• provision of safe water supplies to all communities

• free health education about healthy lifestyle and home safety

• public health precautions and education campaigns to prevent the spread of epidemics

• strict controls on the production and handling of all food sold

• control of industrial processes to ensure safety in the workplace and to avoid industrial pollution

• the national immunisation programme

• provision of baby health centres

• screening of school children for vision, hearing and other health defects

• social services that ensure everyone receives enough money to buy food and no one goes without essential health services because they can’t afford them

• the Australian Drug Advisory Committee ensures that all medicines and medical devices approved for sale are safe and effective

• professional registration of orthodox health personnel is controlled, so that only properly trained and qualified people can provide services

• funding of research aimed at preserving or improving our health

• legislation and education campaigns aimed at preventing road accidents.

Our public health services are as good as any in the world, yet one still hears Australians complaining about them!

Personal hygiene

Efforts we can all make to preserve our health include:

• eating a nutritious diet

• getting enough exercise, recreation and rest to maintain a healthy body and mind

• taking steps to avoid infection

• looking after our teeth

• keeping our bodies clean

• avoiding sun damage to skin

• avoiding behaviour that risks health.

Women are largely responsible for family health: the purchase and preparation of food; keeping family immunisations up to date; health education and setting an example for their children; taking steps to prevent accidents in the home.

Avoiding infection

Infectious diseases used to be the cause of most premature deaths and much chronic ill-health. Nowadays, thanks to immunisation and the use of antibiotics to cure bacterial, parasitic and fungal infections, much suffering is prevented. But infections still occur, and we have as yet no cure for viral diseases (though immunisation can prevent some of the most severe, such as poliomyelitis).

We can do much to protect ourselves against infections by simple hygiene:

• avoiding contact with other people’s body fluids, secretions and discharges

• protecting ourselves against other species that carry disease, such as mosquitos, ticks, fleas and flies

• washing our hands before preparing or eating food and after going to the toilet

• preparing and storing food to minimise the risk of food poisoning (if you’re unsure about this, pamphlets are available free from all State health departments)

• paying careful attention to public-health education about infections, especially during epidemics

• taking all recommended precautions when we are caring for or otherwise in contact with people who have infections

• treating wounds promptly with antiseptic.

Looking after your teeth

Dentists are largely responsible for the increased fife span that we can now all
expect: they are the unsung heroes. As any farmer will tell you, when domestic animals get older and their teeth start to wear out, they can no longer chew their food properly and become malnourished so that they succumb to infection or just fade away. Until the advent of modem dentistry, the same happened to many humans.

These days dentists can ensure that we’re able to chew our food throughout our lives. Look after your teeth and gums: they’re precious. See your dentist regularly; make sure that you know how to brush your teeth so that you don’t injure your gums or wear away your dental enamel. There’s a poster showing the right way to brush in every dentist’s surgery.

Taking health risks

Just about anything we do can be risky, but some behaviours are much more risky than others. Public-health educators have done such a good job that it seems hardly necessary to mention that careless driving and driving with an alcohol blood level over the limit (or being a passenger with a careless or drunken driver), alcohol and drug abuse, smoking and imprudent sexual behaviour are risks that you can choose not to take.

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In recent years there’s been a lot of publicity about Australian women using tranquillisers. Public health authorities became so concerned about the number of women reported to be ‘hooked’ on these drugs that the Women and Tranquillisers campaign was launched in 1986 to make health-care workers and the public aware of the problem.

There are two types of tranquillisers: major and minor. Major tranquillisers are used to treat severe psychiatric illness and their use isn’t part of this problem. The concern is with minor tranquillisers of the benzodiazepine group.

Benzodiazepines are used to treat anxiety, nervousness and sleeping problems, to relieve muscle spasm and to prevent fits in some types of epilepsy. The most commonly prescribed for anxiety and sleep disturbances are diazepam (Antenex, Diazemuls, Ducene, Valium), flunitrazepam (Hypnodorm, Rohypnol), lorazepam (Ativan, Emoten), nitrazepam (Alodorm, Mogadon), oxazepam (Alepam, Murelax, Serepax) and temazepam (Euhypnos, Normison, Temaze).

Who uses minor tranquillisers?

During a 12-month period in the mid-1980s more than six million prescriptions for benzodiazepines were written. More than seven out of ten of these prescriptions were for women.

The National Health Survey of 1989-90 interviewed about 5700 Australians about their health. One question was about medications used during the two weeks before the interview. Sleeping medications and tranquillisers came eighth and ninth respectively in order of frequency of use, with overall rates of five per hundred using sleeping medications and about two per hundred using tranquillisers and sedatives. These medications were used more frequently after the age of 45 for both women and men.

Statistics such as these don’t tell us how many women received one prescription and how many received repeated prescriptions. They also don’t tell us what the drugs were prescribed for. Many single prescriptions may have been for overseas travellers, who are often advised to use them to help reduce the effects of jet
lag. Some repeated prescriptions would have been for treatment of conditions other than anxiety and sleep problems.

The figures don’t suggest that there ail huge numbers of women using minor tranquillisers (though the media jumped on the ‘Women and Tranquillisers’ bandwagon with some sensational reports) but it is a worry if anyone is using them inappropriately when other measures would be more effective.

Doctors often prescribe tranquillisers for women who are worried, sad, panicky, unable to sleep well or suffering the symptoms for which no other physical cause can be found. Bull often the anxiety, sleeplessness and physical symptoms are caused by grief, marriage and family problems, unhappiness at work, financial worries, disappointment and having more to do than you can сорe with.

Anxiety can be a healthy response to stress. It’s natural to feel sad and worried if someone near to you is ill or dies, or ill your marriage breaks up, or when топей problems are getting you down. But anxiety can easily get out of hand.

Taking tranquillisers can calm you down and help you sleep better in a crisis. Taking them for a week or so or once in a while can be useful to help you through a rough patch and will do no harm. A few nights of sound sleep may be all you need to muster the energy to do something about whatever is worrying you. But if you need them for every difficulty that crops up or continue to take them for a long time to block out bad feelings, they can have bad effects.

Though they may help you to sleep and make your problems seem a bit more distant, tranquillisers won’t make you happy as long as those problems persist. They can make you feel listless and drained, unable to think straight, sleepy during the day, or feeling as if you have a hangover. These effects can make you less able to tackle your problems.