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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.

by James Thomas, Thursday, 07 April 2016 | Categories: Womens Health

The menopause isn’t something that women usually look forward to. Though it marks the end of painful period cramps and late night runs to the supermarket for tampons, it’s also a huge lifestyle change that can usher in a whole new collection of uncomfortable symptoms.

The menopause marks the end of a woman’s fertility and is caused by a decline in oestrogen production. In the UK, the average age that a woman reaches the menopause is 51. Typical symptoms include vaginal dryness, reduced sex drive, difficulty sleeping, low mood, night sweats and – of course – hot flushes

In popular culture, the hot flush serves as shorthand for a woman going through "the change". It’s common to see older female characters in films or TV shows experiencing hot flushes – and more often than not, it’s played for laughs.

The reality is that as many as three out of every four women going through the menopause suffer from hot flushes, and some of these will experience up to 30 a day. The sensation varies from person to person, but is generally described as a sudden feeling of unbearable heat, spreading through your body and causing sweating, a flushed complexion and palpitations.

Clinical Trials for New Hot Flush Treatment

Many women seek to avoid the discomfort that surrounds declining oestrogen levels by taking hormone replacement therapy (HRT). According to recent news, though, there may be a new hope on the horizon…

Several news sources have reported on the discovery that the medical compound AZD4901 could effectively combat hot flushes in menopausal women. AZD4901 was originally developed to treat schizophrenia, and it is not known yet how effective it could be as a treatment, as clinical trials are still ongoing. Should the trials be successful, however, we can expect this new option to be in high demand.

Hormone Replacement Therapy

The reason why so many people are excited about the discovery of a potential new hot flush medication is that, until now, the only significant treatment available for menopausal women has been hormone replacement therapy.

There are many different types of HRT, which are prescribed depending upon the particular needs of the patient. Women who have had a hysterectomy will be suited to oestrogen-only HRT, while women who are experiencing symptoms but still having periods will require something called cyclical HRT. When taken correctly, hormone replacement therapy can effectively combat the uncomfortable symptoms of the menopause by tackling vaginal dryness, reduced sex drive, low moods and the dreaded hot flushes.

The problem is that back in the 2000s, a number of studies were carried out which drew a link between hormone replacement therapy and serious conditions such as breast cancer, ovarian cancer and heart disease. As a result, many women stopped using HRT, and to this day it is a treatment, which is surrounded by controversy. Some doctors will rule it out entirely, while others will tell you that it is fine to use for a short period. However, one recent study carried out by New York University found that there were zero health risks associated with taking HRT over a long period.

The study looked at a sample group of 80 women who had been taking HRT for an average of 14 years and found that there was no higher incidence of cancer, heart disease or diabetes in this group, than in the control group who had never taken HRT. And – even putting this particular example to one side – the common consensus in the medical community is slowly but surely moving back in favour of HRT again. Not all doctors will recommend hormone replacement therapy, but many will agree that it is generally safe for women to use for a few years.

HRT at The Online Clinic

For women going through the menopause who are suffering unpleasant symptoms, the rigmarole of seeking treatment can seem like another unnecessary burden. The good news is that you can order hormone replacement therapy safely over the internet from trusted online doctor services such as The Online Clinic.

If you don’t have time to visit your GP, or if you simply value the convenience of an online service, head to the Online Clinic. Here, you can undertake a private online consultation, where one of our doctors can recommend appropriate HRT options.

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by Robert MacKay, Monday, 19 August 2013 | Categories: Womens Health

Even though female contraception was introduced more than 50 years ago, it is still a topic that causes much debate around the world. Recently, we were surprised to read the reactions to research indicating that there was a need for pericoital contraceptives among women who attended family planning clinics.

The research, which was published in Contraception, took place in family planning clinics. The researchers surveyed 1616 women who attended clinics about their attitudes to using pericoital pills. The purpose of those pills is to be taken right before intercourse. Within that sample, 635 women had visited the clinic to have advice on abortion. The key findings indicated that 69% of the women visiting the centres to discuss abortion were positively inclined towards the contraceptives and 50% of patients who had visited the clinics for family planning would consider the treatment. The researchers stressed that there was a need for further research to consider exactly what demographics would benefit from this treatment the most and whether the pill would be effective.

To us this sounds like standard research that should not really cause too much controversy. However, as the study came in the wake of Bill and Melinda Gates awarding funding to an organisation to consider the efficacy of such treatment, the issue became more real to laypersons and politicians.

Perhaps that is why several news sources, including New York Magazine, dubbed the pill as the “slut pill” and compared it to the morning after pill. Many debates online appeared to focus on it as an easy solution that only a certain kind of woman could use. Yet, the researchers clarified that this treatment would probably be the most suitable for women who did not have regular intercourse.

Passing off this research as something that relates to promiscuity and assumed immorality completely misses the mark of the purpose of the current research. Based on our experience, we think it is fair to say that unprotected sex is far more common than it may be made out to be in some of the debates. It is also fair to say that not all women have equal access to contraceptives due to a multitude of reasons. From the sounds of it, the pericoital pill appears to have less severe effects than the morning after pill.

Clinicians that understand the sensitive nature of sexual health treatment also understand the need to lessen barriers to treatment and listen to research rather than debates. However, based on what we know about the pericoital pill today it is clear that more research is needed to substantiate the findings, to understand the potential risks and benefits and to evaluate the cost of the treatment. If future trials come to find a safe and effective pericoital pill, then we see little reason for denying women this choice.

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