Health News

Women vary enormously in their response to different medications, so what is ‘the most effective type of treatment with the least side effects’ for one woman may be an ineffective type with bad side-effects for another. Fortunately, there are over 20 different ways in which oestrogens and progestogens can be combined into hormone replacement therapy, so with your doctor’s help you should be able to find one that is right for you.

However, there are two factors that may prevent you ever getting that far: one is that the initial side-effects put you off the whole idea of HRT and you decide just to give up without trying different types; the other is that your doctor may be unable or unwilling to suggest alternatives for you. With the best will in the world, no doctor is able to remember every variety of every form of treatment that is available for all his patients, so he has his ‘favourites’ that he uses most of the time because he knows they work well. If one of them doesn’t work, he then has to start referring to the various publications that list different forms of treatment, and just hope that the one he chooses is the right one for that particular patient. Usually, when the average general practitioner suggests that HRT may be the answer to your menopausal problems, he will almost certainly prescribe his ‘favourite’ preparation because his experience has shown it to work with most of his patients. It may well work for you, or it may not. It may relieve your symptoms without producing side-effects, or it may not. However, if this one doesn’t help, another one probably will.

The number and types of HRT preparations available have increased enormously in the last 10 years, and are still increasing each year. Those most commonly used in the UK are in the form of tablets, patches and implants, all available in different strengths. Less commonly used here, but varying in popularity in other countries, are creams, gels, pessaries, suppositories and injections.

Some preparations come as combined ‘calendar packs’ of oestrogen and progestogen, others come with each hormone packed singly. If you are taking a combined pack, and can’t get the balance of oestrogen and progestogen right to give relief of symptoms without side-effects, your doctor can prescribe the hormones separately to get the right dosage of each. Both hormones are available in different strengths from different pharmaceutical companies, which allows great flexibility and should make it possible for you and your doctor to get it right.

With the exception of implants, any treatment can be stopped at any time, or the dosage can quickly be adjusted, but you will probably get a return of menopausal symptoms if you stop suddenly.

The first decision you and your doctor will make is whether HRT is suitable for you at all. The next thing to consider is whether you take HRT in an oral form, that is as tablets, or whether a non-oral route (patch, implant or cream) would be better.

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The formation of adhesions — a risk of any abdominal surgery — must be avoided if possible because of the associated pain and interference with normal organ function. Tissues that were never meant to be joined can become attached to each other and problems like chronic pelvic pain and infertility may result. To minimise the chances of adhesions forming, tissues must be handled gently, appropriate irrigation solutions or an adhesion barrier used within the abdomen, and blood loss minimised. The extra cost to the patient of taking these precautions is less than $150, a small price to pay for the prevention of potentially serious problems. The use of laser techniques and diathermy also appears to reduce the risk of adhesion formation. Reconstruction of the uterus after removal of fibroids requires skill and care. Recent research suggests that when sutures are avoided during myomectomy, adhesions are less likely to develop. On the other hand, the absence of sutures may lead to weakness of the uterus.

An occasional serious complication of hysteroscopic myomectomy is perforation of the uterus. It may occur if the surgeon cuts deeply into the wall of the uterus to remove parts of an embedded fibroid. To minimise the risk of this happening, some doctors simultaneously perform a laparoscopy, a procedure in which a small incision in the abdomen is used as a porthole to enable visual inspection of the pelvic organs, including the outside wall of the uterus. Others think this is of doubtful value. Most women return home within one to three days of a hysteroscopic or laparoscopic myomectomy and it is usual for surgeons to check on each patient’s progress about six weeks later.

For open myomectomy, the pattern of post-operative illness and time to full recovery is similar to that for abdominal hysterectomy. That is, the average length of hospital stay is four to seven days, pain persists for several weeks and full recovery may take several months.

Women having a hysteroscopic or laparoscopic myomectomy experience less pain and a shorter convalescence (by about two to four weeks) than those having either open myomectomy or abdominal hysterectomy. The cost of these procedures in Australia is considerably less, in the short-term at least, than the cost of an open myomectomy (around $1500 for hysteroscopic myomectomy and $2200 for a laparoscopic myomectomy compared to $3825 for an open myomectomy). Because of the relatively recent introduction of hysteroscopic and laparoscopic techniques to perform myomectomy, it will be some time before we know the extent to which fibroid recurrence and complications alter these costings.

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‘Joan, darling, I am going to see you soon’: the husband was repeating this whilst asleep. Next morning his wife Pat was very angry as she had overheard this other woman’s name; a big scene followed. The husband could not think of anyone he knew called Joan, and explained that it must have been Joan Collins, as she was to be on television that night.

In fact, this is extremely rare. People who sleep-talk do not confess any secrets that they would not say whilst awake. The accuracy of these messages in sleep-talking are always in doubt. Sleep-talking can happen during both REM and NREM sleep. Some experts report that talk during REM sleep is often charged with emotion, relating to the contents of the dreams taking place. In contrast, talk during NREM sleep is deficient of any emotional content.

Normally sleep-talking consists of simple phrases or single words, such as ‘Yes, that is it’, ‘No, oh, no’, or ‘Well done’. Sleep-talking is more common in children and is normally quite harmless. There is no need for any treatment.

Before the days of sleep laboratories, it was believed that sleepwalking, night tenor, and children’s bed-wetting happened during dreaming. Nowadays, with the help of the sleep laboratories, we know mat these related phenomena occur in the deep sleep stages of NREM sleep, and are not features of dreams at all.

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