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by James Thomas, Friday, 09 February 2018 | Categories: Womens Health

January 22nd - 28th is Cervical Cancer Prevention Week; a Jo’s Cervical Cancer Trust initiative which this year is focusing on the different ways in which women can take small steps towards reducing their risk. By understanding more about the symptoms of cervical cancer, and its risk factors, Jo’s Trust is hoping to lower cervical cancer rates in the UK through education, knowledge, and simple screening.

What is Cervical Cancer?

Cervical cancer occurs when cancerous cells develop in the cervix, and it’s more common than many people think. In fact, cervical cancer is the 13th most common cancer in women (1), and around 3000 new cases are diagnosed each and every year in the UK (2). Sadly, despite high survival rates – women diagnosed with Stage 1 cervical cancer have an 80-99% 5-year survival rate – 3 women lose their lives to the disease every day (3). Many women don’t realise that they have cervical cancer until a later stage.

Improving Awareness

The Jo’s Trust Cervical Cancer Prevention Week is designed to help women become more aware of the signs and symptoms of the disease. The ultimate aim is to improve awareness of the different ways that women can minimise their risk of developing cancer, and take simple measures to ensure that if they do have the disease, the cancer is diagnosed during the early stages for the highest chance of survival.

Here in the UK, many women are not taking advantage of the available screening methods for cervical cancer. There are a number of screening methods available, but one of the most well known techniques is cervical screening, or the ‘smear’ test. Each year, 5 million women in the UK aged between 25-64 are invited for cervical screening (4), although an estimated 1,250,000 won’t make an appointment (5). These statistics are worrying, as it’s believed that regular smears could prevent 75% of cervical cancer cases.

It’s Time to be Proactive

Cervical Cancer Prevention Week is the perfect time for women to be brave, be proactive, and take control. A good starting point is to learn more about the causes of cervical cancer, and how to reduce risk factors. There are many different aspects that can contribute towards the development of cervical cancer, such as chlamydia, smoking, family history, and the use of oral contraceptives, although 99.7% of cervical cancers are caused by the human papillomavirus infection, or HPV (6), which can affect cells.

HPV isn’t always linked to cervical cancer. In fact, HPV is very common and, in many cases, the body is able to successfully fight off the virus without causing any long lasting damage. However, there are some specific forms of HPV – HPV 16 and HPV 18 – which are present in around 70% of cervical cancer cases (7), suggesting that these are typically ‘high risk’ forms. Fortunately, women can determine if they are considered high risk for these forms of HPV by taking a quick and simple HPV screening test at home.

Sharing Knowledge

The Jo’s Trust campaign is also encouraging women to share their knowledge, and ensure that younger girls are growing up armed with the information they need to help protect themselves from disease. The HPV vaccine is now available on the NHS for free for girls aged between 12 and 18, and protects against 4 different types of HPV: HPV 16 and HPV 18, which are most commonly associated with the development of cervical cancer, along with HPV 6 and HPV 11, which can contribute to genital warts.

Reduce Your Risk

Through small lifestyle changes, such as using condoms and stopping smoking, and through regular screening including quick at-home HPV tests, and NHS cervical screening every 3 years (for women aged 25 - 49) or every 5 years (for women aged 50 - 64), women all across the UK can give themselves the best chance to protect themselves from cancer, or catch the disease early to improve their survival rate.

by James Thomas, Tuesday, 10 October 2017 | Categories: Womens Health

World Contraception Day

World Contraception Day is an international campaign day launched ten years ago by the European Society of Contraception (ESC). The ESC was concerned that the high number of unplanned teenage pregnancies and the rate at which young people were being infected with Sexually Transmitted Infections (STIs) because they were not taking steps to protect themselves during sex.

World Contraception Day has the support of 16 Non-Governmental Organisations, medical and scientific bodies and governmental organisations from around the world. The day aims to improve young people’s awareness of the various methods of contraception available to empower them so they can make an informed choice when it comes to their reproductive and sexual health.

Since it was founded in 2007, the Your Life campaign has encouraged young people around the globe to talk more openly about sex, contraception and protection against sexually transmitted diseases. The various educational and scientific events, which are held in over 70 countries, as well as online, have reached an estimated 110 million people.

In order to spread the message about safe sex, 10 World Contraception Day Ambassadors have been appointed as part of a 3-year project with Women Deliver, a leading global advocate for the health, rights and well-being of girls and women. These ambassadors are young people from around the world. Each ambassador will tell their own story so they can offer a unique perspective on what it means to be a young person seeking information about sexual health and reproduction in their local communities.

Unplanned pregnancies are a serious public health issue. It's estimated that 225 million women who would like to prevent pregnancy do not use an effective method of contraception.

To celebrate World Contraception Day, here is a quick guide to the various types of contraception, which are available. 

Non-hormonal Contraception

Non-hormonal methods of contraception usually take the form of a barrier, which is placed between the sperm and the ova. The forms of non-hormonal contraception, which are currently available are:

  • Condoms
  • IUD coil
  • Diaphragm
  • Cervical cap

Hormonal Contraception

Hormonal contraception - commonly referred to as "the pill" alters the hormonal balance of the female body to suppress ovulation. There are two forms of hormonal contraception. 

Progestogen-only Method

The progestogen-only pill causes the cervical mucus to thicken and prevents the ova from attaching itself to the lining of the uterus.

The Combined Method

The combined pill contains the hormones oestrogen and progestogen. While the progestogen thickens the cervical mucus, the oestrogen suppresses the release of the ova.

Hormonal Patches and Implants

If you do not want to worry about taking a pill every day, you may wish to opt for a hormonal patch or implant. Hormonal patches are applied to the skin once a week and have the same effect as oral contraceptives.

A birth control implant is a small plastic rod, which is implanted under the skin in your arm. The implant will slowly release hormones into your body to prevent you from becoming pregnant. Implants are a long-term solution, which can last up to 3 years.

It is important to remember that birth control methods will not protect you from sexually transmitted infections. The only effective protection against STI is to use a condom.

You can learn more about contraception and safe sex by visiting The Online Clinic.

by James Thomas, Saturday, 11 March 2017 | Categories: Womens Health

The term cystitis is used to describe a bladder inflammation, generally caused by a UTI or urinary tract infection. It's a common mistake to believe that only women can get cystitis; in fact, men are also able to develop it. The likelihood of cystitis in men is lower for one simple reason – the relative length of the urethra in men and women. In women, the potential transfer of bacteria into the urethra is made easier as the opening of the urethra is closer to the anus. This is not the only possible cause of cystitis, but it does explain the varying rates of the condition.

The condition known as interstitial cystitis, however, is somewhat different, both in terms of symptoms and of possible treatments. The main symptoms include a sensation of pain in the bladder (it's sometimes known as bladder pain syndrome, or IC/BPS) but without a clearly identifiable infection, as might be expected with cystitis. Pain like this is experienced in the lower abdomen, and is coupled with unusually frequent, strong urges to urinate. These symptoms may come and go in cycles over a few months.

The differences between cystitis and IC have led some researchers to believe that the condition is misleadingly named, and in fact the exact causes of IC are the subject of debate. Allergies have been suggested as a possible cause, as well as problems with the lining of the bladder or the pelvic floor muscles. It's also possible that IC may sometimes be a symptom of a separate condition (e.g. irritable bowel syndrome).

Possible new treatments for interstitial cystitis

The US-based Interstitial Cystitis Association suggests that up to 8 million American women suffer from IC, with possibly half as many men. The confusion surrounding the causes of IC (as opposed to cystitis) has led some US researchers to propose a step-based programme of treatments aimed at minimising its symptoms. In the early stages of treatment, these include lifestyle and dietary changes and advice on pain management. Dietary changes may include gradual elimination of certain types of food and drink, in order to find out which may be triggers for the symptoms. Some over-the-counter medications may also be prescribed by GPs.

The "steps" in this kind of approach to treating IC are ordered by risk factor; if the least risky strategies provide acceptable relief, there's no need to proceed to the next level. As an example, the fourth proposed stage of treatment may include Botox injections, while the following stages could involve surgery.

Cystitis: symptoms and treatment options

Cystitis itself is easier to treat than IC, and in fact some over-the-counter medications, as well as antibiotics in some cases, are available from The Online Clinic. While milder instances of cystitis often clear up without treatment, if you experience frequent symptoms, or the condition doesn't get better after a few days, you should see a doctor. Men with cystitis symptoms should always seek medical advice, and children complaining of similar symptoms should also be taken to a doctor. More severe symptoms may include fever and/or passing blood during urination.

Preventative measures are centred around avoiding bacteria entering the urethra (allowing bladder infections to develop) as well as certain lifestyle changes. While cranberry juice has long been thought of as a cure or prevention, there's very little scientific evidence that this is the case. Making sure you've completely emptied your bladder when you urinate is recommended, as well as wearing looser underwear made from natural fibres (e.g. cotton). Drinking plenty of water in order to flush out the urinary system is also a good idea.

It's also possible that irritants in certain kinds of shower gels, shampoos, bubble baths and similar products could be a problem; avoid perfumed varieties, and if possible take a shower rather than a bath. If you suffer from cystitis, try avoiding any drinks containing caffeine. These will not cause cystitis in themselves, but may aggravate the symptoms. Some medical professionals believe that the use of a bidet could be a risk factor for cystitis, as bacteria can be washed upwards towards the urethra.

It is important to see a doctor if cystitis symptoms don't clear up, as there is a possibility of contracting a kidney infection in some cases. However, cystitis is generally simple both to diagnose and to treat.

by James Thomas, Saturday, 07 January 2017 | Categories: Womens Health

How does HRT affect dementia risk?

Hormone replacement therapy (or HRT) has long been the subject of controversy. First made available in the 1940s, it was created as a means of tackling the unpleasant – and for some women, debilitating – symptoms caused by the menopause.

In the 1990s and 2000s, studies were undertaken to study HRT’s long-term effects. When they found evidence that it could increase a woman’s risk of cancer and heart disease, the reaction was swift. Medical bodies began urging doctors to prescribe it only in its lowest effective doses, and many women stopped taking it altogether.

Today, those three letters still evoke a lot of uncertainty in patients and doctors. Many doctors feel uncomfortable prescribing it; many more menopausal women automatically rule it out as a potential treatment because of the risks it may carry.

In an interesting turn of events though, the studies that caused the initial panic have recently been challenged. According to new research, it now looks like HRT is perfectly safe for menopausal women to use. In fact, the latest studies seem to suggest that hormone replacement therapy could be seriously beneficial to post-menopausal women when it comes to staving off dementia.

The Menopause and Dementia

Earlier this year, it was reported that early menopause as caused by surgical removal of the ovaries is linked to a reduction in memory and thinking skills. The fear is that this could in turn lead to early-onset dementia and Alzheimer’s.

It isn’t understood precisely why the removal of the ovaries might have these worrying effects, but the doctor running the study, Gillian Einstein, believes that this indicates the importance of oestrogen in healthy brain function for women.

One fascinating offshoot of this study is that hormone replacement therapy (which artificially boosts oestrogen levels) could now play a seriously important role in maintaining brain health for post-menopausal women. In fact, this isn’t just speculation – in 2014, researchers at the Stanford University School of Medicine found that, when given to post-menopausal women who were at risk of dementia, HRT actively prevented brain degeneration.

While the sample size used in this study was too small to draw any definitive results, it is interesting to consider this research in conjunction with Dr Einstein’s more recent study. If oestrogen is the key to maintaining a healthy brain after the menopause, then it seems only logical that HRT would be the way forward.

All dementia-fighting powers aside, there are plenty of reasons why HRT would appeal to a menopausal woman living with unpleasant symptoms.

The Benefits of Hormone Replacement Therapy

The menopause is a natural part of ageing, which occurs when a woman’s oestrogen levels begin to decline. This predominantly causes period cessation, but other symptoms include:

  • Hot flushes, which can incorporate heart palpitations, sweating, and skin reddening

  • Night sweats and problems sleeping

  • Vaginal dryness, which can cause pain and discomfort during sex
  • Anxiety and low mood

  • Reduced sex drive
  • Difficulty concentrating

Hormone replacement therapy works by boosting oestrogen levels artificially. In turn it helps to tackle all of the symptoms listed above, as well as osteoporosis (the weakening of the bones), which is more common in post-menopausal women. HRT is usually taken for a few years, after which the doses are gradually reduced and treatment eventually ceased.

Types of HRT

There are many different types of HRT available, and the exact kind you are prescribed will depend upon your medical history, symptoms, and how advanced your menopause is.

Women who have had a hysterectomy (i.e. their womb has been removed) can safely take oestrogen on its own; women who still have their womb will have to take a combination of progesterone and oestrogen.

Cyclical HRT is recommended for women experiencing HRT but still having periods, while continuous combined HRT is recommended for post-menopausal women who are no longer having periods.

HRT treatments also come in a variety of preparations. You can take tablets, use patches that stick onto your skin, apply an oestrogen gel directly to your skin or vagina, or even have an implant fitted that gradually releases hormones into your bloodstream.

To find out more about HRT, or to obtain a safe prescription through The Online Clinic, click here.

by James Thomas, Saturday, 10 September 2016 | Categories: Womens Health

Emergency contraception is something that most sexually active heterosexual women end up using at least once in their life. No matter how well prepared we are, accidents happen; whether it’s a condom splitting or slipping off, a missed pill, or simply getting caught up in the heat of the moment.

The good news is that the morning after pill and the emergency IUD (coil) are now widely available in the UK from NHS centres, private clinics and high street pharmacies.

In a shocking turn of events, though, the most popular form of emergency contraception has been challenged by a new study, which claims that the morning after pill Levonelle is ineffective in women over a certain weight. Recent research by an American university has shown that emergency contraception containing levonorgestrel (the active ingredient in Levonelle) is less effective in women considered obese. More specifically, the amount of levonorgestrel in their bloodstream after taking the morning after pill was 50% lower than in women of a healthy weight.

The woman leading the study, Alison Edelman, spoke to Women’s Health about her findings, and discussed how doubling the dose of levonorgestrel for obese women seemed to be an effective solution to this problem. However, she felt she could not recommend this as an appropriate course of action until further research was carried out.

Misleading Information

While this new research is cause for concern, it’s important to bear a few things in mind. First of all, this study only looked at ten women – a very small sample size. Secondly, many press outlets are conflating Edelman’s results with an entirely different story which originated in 2013.

Three years ago, European morning after pill Norlevo hit headlines when it released packs printed with a new warning. According to this warning, Norlevo (which contains the same dosage of levonorgestrel as Levonelle) was:

  • Less effective for women weighing 75kg (165 pounds/11st 11lb)
  • Ineffective for women weighing over 80kg (176 pounds/12st 8lb)

This warning was later removed from packs, following advice from the European Medicines Agency which found that: "the data was [sic] not robust enough to conclude with certainty that contraceptive effect is reduced with increased bodyweight".

Despite this retraction, many press outlets reporting on Edelman’s research have incorporated Norlevo’s statistics into their stories – presumably in a bid to create better headlines! In actual fact, the weights suggested by Norlevo would not indicate obesity in the average woman.

Using the NHS BMI calculator, you’ll find that a 25-year-old woman who is 5’5’’ tall, weighs 165 pounds (11st 11lb) and is moderately active has a BMI of 27.4. This puts her firmly in the category of overweight – but not obese. Even a woman weighing 176 pounds (12st 8lb), who is similarly 5’5’’ tall and moderately active, has a BMI of 29.2. This is still classed as overweight, and is only just on the cusp of clinical obesity.

If Edelman’s research is to be trusted, a woman would have to have a BMI of over 30 for the morning after pill to be ineffective. Coupled with the other characteristics listed above, that works out to a weight of 181 pounds (12st 13lb).

Is it still safe to take the morning after pill?

Yes, it is still safe to take the Levonelle morning after pill as a means of preventing pregnancy. If you have had unprotected sex and you do not want to get pregnant, it is still better to use Levonelle than nothing at all – even if you are overweight. However, if your BMI does place you in the category of obese, and you are concerned that Levonelle may not work, you can always speak to a doctor about using an alternative form of emergency contraception.

There is currently no evidence to suggest that the efficacy of the morning after pill EllaOne is affected by weight. Unlike Levonelle, EllaOne can be taken up to five days after unprotected sex (Levonelle only has a window of three days).

You can also have the emergency IUD (coil) fitted up to five days after unprotected sex. This can only be done by a medical professional, but it is free from NHS clinics.

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