Health News and Information

The hot flush. This is the most common peri-menopausal symptom. Hot flushes may precede menopause, or even the onset of irregular cycles. It is a feeling of warmth usually in the head, neck and body, and may last between fifteen and sixty seconds. It is sometimes associated with perspiration, and may happen as often as thirty times a day. Some situations may precipitate hot flushes, particularly being in a warm room, or bed, drinking or earing hot foods, or being anxious. It can be immensely frustrating and embarrassing. Even though the woman having the flush does not always look flushed she may feel like her face is on fire. It can interrupt her train of thought, her conversation, her work, her sleep.

Hot flushes have been linked to surges of one of the hormones produced in the brain (luteinizing hormone), and may persist for many years after the last period.

The vagina. Oestrogen helps to keep the vaginal skin elastic and well lubricated. When there is less of it around the vaginal skin tends to become thinner, and less lubrication occurs. This can lead to painful dry intercourse, and vaginal irritation. This can affect a woman’s desire to have intercourse, and her arousal.

The supporting structures around the vagina, the muscles and ligaments, can tend to lose their strength. As a result there may be sagging of the vaginal walls, and some prolapse of the uterus (the uterus tending to drop down into, and sometimes out of, the vagina). This may give rise to a dragging sensation, or even a ‘lump’ in the vagina.

The front and back walls of the vagina may sag. This can lead to problems with passing urine and bowel actions, or also give rise to a dragging feeling or lump. These problems are not confined to menopausal women. However they do tend to become more obvious around menopause and after, due to the decrease in oestrogen levels.

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Q. Do I need my partner’s consent to have a vasectomy?

A. Legally, only the person having the vasectomy needs to sign the consent form. Of course, if you have a partner, it is best if you have talked it over and both of you agree that your having a vasectomy is the best decision. Although it is not a legal requirement, some doctors may request your wife’s consent. You may want to check with your doctor to see if this is the case.

Q. How long do I have to wait after my vasectomy before I can have sex?

A. You should wait at least a few days, but basically you should wait until you feel comfortable. It may be a few days or a couple of weeks before you feel ready. It’s up to you.

Q. Will having had a vasectomy affect my erections or anything about the way I have sex?

A. No. Everything will function as usual. The only thing that will change is that when you ‘come’ there will be no sperm in the fluid you ejaculate. You won’t even be able to see or feel any difference there.

Q. I have heard that you can change your mind down the track and have the vasectomy reversed so you can have more children if you want to. Is that true?

A. Most men, but not all men, can have an operation to join the vas again, but after this they still may not be able to father a child. We don’t really know why a pregnancy doesn’t happen if the vas are rejoined and even if sperm is found in the semen again. Sometimes it just doesn’t happen. The main thing is that there is no guarantee that a reversal operation will work. In fact you should look at vasectomy as final. So if you have any doubts, it’s best to wait and use another method of contraception until you feel sure it is what you want. Then, if your life changes unexpectedly later on, you will know that it was definitely the best decision at the time and that you didn’t make it lightly.

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Some other questions people ask about Natural Family Planning

Q. I’ve heard there are personal fertility computers which can make the calculations of fertile days easier. Are these available in Australia?

A. You are probably thinking of Persona, which is a little handheld computer that analyses homones in a woman’s urine and gradually builds up a pattern of her fertile and non-fertile times. These are not available in Australia but it may be possible to order one from Britain where they are made and are used by many women using natural family planning.

Q. Can I successfully use natural family planning as I get older and my natural fertility decreases anyway?

A. Anyone can learn to recognise the changes in their body which signal the beginning of a fertile time in the cycle. As you get older, though, the cycles tend to be a bit more irregular and it can become a little more difficult to rely on your previous cycle length.

Q. Can I use this method to help me fall pregnant if I want to?

A. Yes the very same changes can be used to help a woman predict the most fertile time in her cycle and therefore increase her chances of falling pregnant if that is what she wants to do.

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DMPA is a liquid that contains the hormone progestogen, similar to the progestogen in the progestin-only pill. It is given as an injection into the muscle in your arm or buttocks. When people are talking about injectable “hormonal contraception they sometimes just call DMPA ‘the injection’.

The most important thing about DMPA is that it stays in your body and keeps working to stop you getting pregnant for three months at a time.

Are there different types of DMPA? At the moment mere is only one kind of hormone injection you can get m Australia. The same injection is available under two different trade names, Depo-Provera and Depo-Ralovera.

How does DMPA work? DMPA stops a woman’s ovaries from releasing eggs. It makes the mucus m the opening of the cervix thicker, so sperm cannot get through, and it changes the lining of the uterus, so that if by some chance an egg were fertilised, it couldn’t grow there.

How effective is DMPA? DMPA has a 0.1 to 0.6 percent failure rate, which means it is really very effective. If 100 women used DMPA as their method of contraception for a year, there is only a slight chance that even one of them would have an unexpected pregnancy.

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A 35-year-old man consulted his doctor and complained that his bowels were interfering with his job. He had to go to the toilet so frequently and had so much gas and bloating that meetings had become an embarrassment. The strange thing was that this disruption only occurred during the day. At night he slept soundly. He also looked well and had not lost weight.

The man explained how he would have cramps and need to defecate two or three times in the morning, again in the afternoon and again in the evening. He often had a feeling of incomplete emptying and sometimes there was mucus in the bowl.

This disruption usually lasted for two or three weeks, disappeared for a month or two and then returned in the same pattern. He couldn’t relate its re-emergence to any particular event and said this had been continuing for years. Recent publicity about bowel cancer had prompted his visit to the gastroenterologist.

This man displayed typical symptoms of irritable bowel syndrome (IBS), which is such a common disorder that one in seven people in the community suffers from it. IBS is also known as spastic colon, mucous colitis or nervous bowel. It should not be confused with inflammatory bowel disease, which is more serious and can cause ulceration of the bowel wall.

The bowel is basically a muscular tube which stores and digests food. IBS is a disorder of the nerves of muscles of that tube. Despite being so common, many aspects of IBS remain unknown. However, it is known that IBS does not lead to cancer and does not require surgery. Symptoms particularly include cramping (often on the left side of the abdomen, but it may mimic heartburn or backache), bloating and an urgent need to move the bowels. The stool may be loose and watery, and might contain white mucus. Eating may make it worse and defecation or passing gas brings relief. There is no fever or bleeding and no obvious reason as to what might have brought this on.

Mysteriously, the diarrhoea may give way to constipation, but abdominal pains and a lot of gas may persist. The condition can correct itself and then return when least expected or wanted. For example, before an important occasion about which a man may really feel tense.

A feeling of incomplete emptying of the bowel, nausea and swelling of the stomach which increases throughout the day, fatigue and lethargy are also common symptoms.

In the vast majority of cases the cause is unknown. Most people who suffer from the disorder have an oversensitive bowel, but the factors which trigger the sensitivity are mostly unknown, although stress and diet may be important.

Stress can affect muscular contractions and bowel secretions. In some people the oversensitive bowel overreacts to normal stresses. In others, lifestyle choices expose them to more stress. In all cases, however, worrying about the cause of the symptoms can create a vicious circle, making the symptoms worse.

The impact of diet varies between people. In some, too little fibre or too much may provoke symptoms. Insufficient fibre is usually associated with constipation. Fatty foods can slow the movement of the food through the bowel and make bloating and constipation worse. Sugars in milk and beverages, sweets and some fruits may provoke diarrhoea.

A bout of gastroenteritis can trigger symptoms. The symptoms may persist or even begin long after the infection has cleared from the bowel.

IBS usually starts under the age of thirty-five. Up to half the consultations with gastroenterologists in Australia are for this condition. There is no diagnostic test for it. Diagnosis is usually made by taking a thorough history and by doing tests to exclude other diseases, such as bowel cancer.

It is not necessary to test everyone, but if, for example, a man over forty began experiencing the symptoms, tests would have to be done, especially if he had rectal bleeding, weight loss or nocturnal diarrhoea.

There is no universal treatment for IBS. Treatment is usually individualised and may include diet modification, stress management and medication.

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