COMING NEXT: the doctor's next topic is sex addiction and
promiscuity. Read his article, Am
I suffering from sex addiction just like Ulrika Jonsson? E-mail your
question for answer online on Wednesday and read other recent topics here
I had breast cancer 17 years ago. My mother, grandmother and great aunt had
all died of this disease. Because the tumour was encapsulated I had a
lumpectomy followed by Tamoxifen. During this treatment I was invited to go
on the Tamoxifen trial and this lasted for eleven years. At the end, no one
discussed with me the implications of this lengthy drug-taking,whether there
were there any side effects or longer-lasting consequences. Only recently I
read that there was a risk of DVT. Fortunately I had already had a
hysterectomy so was not in danger of cancer in the womb. The only side
effects that do distress me are my thinning hair and facial hair, which I
think must be connected to the supression of oestrogen. I would be very
interested to here your thoughts on this for even though it is a long time
ago, it is always in the back of my mind. Incidentally, after my last
check-up the hospital nurse told me that they were now stopping all
follow-up checks after five years which seems far too soon. Annie
Croscbie, Berkshire
There is evidence that side effects may outweigh the advantages of taking
Tamoxifen if continued for more than five years. If further hormonal
adjustment is considered necessary it is usual to switch to an aromatose
inhibitor. In many cases this switch takes place after two or three years
and in some cases, and with some doctors, aromatose inhibitors are now being
used as primary front-line treatment. Patients taking aromatose inhibitors
rather than Tamoxifen need to take additional precautions against
osteoporosis, and to be always on the lookout for cancer of the uterus.
Watching for both these conditions has now become standard treatment. The
incidence of cardiovascular disease is in fact slightly reduced in patients
taking Tamoxifen. One of the bisphosphonat drugs is usually prescribed to
prevent osteoporosis. The application of Regaine, just as is prescribed for
male pattern baldness, is usually recommended for women. It is equally
effective in both sexes and helps somewhere around 50 per cent of patients.
The earlier it is used the better and it must be used continuously. I would
agree with your opinion that with a family history like yours five years of
treatment would have seemed too short. You should now discuss with your own
GP and your consultants for pros and cons of going on to an aromatose
inhibitor, and should in any case continue to have regular mammographs.
I was diagnosed with breast cancer in 1994 and had both ovaries removed two
years later to lessen the chance of recurrence. I was tipped into a sudden
menopause at the age of 39. Four ghastly years followed (hot flushes, etc)
before my consultant took pity on me and prescribed Tibolone. Things
improved drastically and life was worth living again. Four months ago my GP
advised that I slowly come off Tibolone because of the risk of stroke, heart
problems and breast cancer returning. Reluctantly I am now off the HRT and,
predictably, the hot flushes have returned along with many of the other
spirit-sapping symptoms of menopause. I lead an active life (tennis, sheep
farming and 8-year-old daughter) and would give anything to have my
HRT-helped life back. I understand that this would not be without personal
risk - have you any suggestions? I have tried every herbal remedy on the
market and nothing seems to work. Ally Gregory, Chagford, Devon
The only answer is to come off Tibolone even more gradually than you have
already done. You should of course be very assiduous in having regular blood
tests to exclude any likely problems that could make cardiovascular disease
more likely and you certainly need mammography annually until very old age.
Herbal remedies may not help but I am not yet certain that the use of
phytoestrogens have yet been fully explored.
Your article
on Michael Baum and his expertise in the treatment of breast cancer was
very interesting. However, most of the articles I read in the news refer to
treatment for hormone receptor positive cancers for which tamoxifen and the
aromatase inhibitors are prescribed after surgery. Very little is ever
mentioned about women, such as myself, who had hormone receptor negative
cancers and who have to rely on surgery, chemotherapy and radiotherapy
treatment but for whom no other treatments are available. Are you aware of
any research being carried out on this particular cancer and if any drugs
are in the pipeline? Judy Woollett
Professor Mike Baum and Professor Jeffrey Tobias of University College London
are both working on intra-operative radiotherapy. This will make
radiotherapy for breast cancer more efficient, less time-consuming and less
destructive to adjacent tissue. There is also continuing research into the
best use of chemotherapy for hormone negative breast cancer, even if these
patients have at the moment, as you suggest, drawn the short straw in breast
cancer as they’re not likely to be helped by hormone therapies.
My daughter aged 45 has recently been diagnosed with breast cancer and is
due to see a surgeon next week to discuss surgery and breast reconstruction.
Question one: Is there any evidence to show that the incidence of breast
cancer in younger women is increasing? Question two: I understand that some
tumours are hormonal dependant, in my daughter's case she was on the pill
for a number of years and then Depot-Provera. Is there any evidence linking
either of these with breast cancer? Question three: Why is breast screening
restricted to older women? Michael Page
There is some evidence that more cases of breast cancer are being diagnosed in
younger women but it’s not entirely certain if this is an increase in
incidents or an improvement in diagnostic methods. There is a greater
awareness that some younger women do develop breast cancer and that it is
necessary to bear this in mind and to sort out those who have an increased
risk. If there is an increased risk they should, despite their age, be
examined regularly.
If the incidence is increasing there are various factors that may be
responsible. Anything that increases the overall lifetime exposure to
estrogens is likely to be responsible. This includes early use of the pill;
the later age at which women have pregnancies; the longer gap between
pregnancies; the lower likelihood that they will breast feed and that if
they do breast feed it will be for weeks rather than months and the use of
HRT (now abandoned except for the treatment of severe symptoms for a short
period). Good feeding and an increase in weight is also a factor and it
seems that alcohol is particularly guilty in this respect.
i am 46 the nurse put me on levothyroxine 25mg about a month ago for underactive thyroid, i have felt much worse and i went back to the doctors and he said my level was 6.6 so i could come off them and that i didnt need to be on them in the first place. could you tell me if this is normal plz .
kim , tamworth, united kingdom
i am a 62 year old woman who is experiencing hot flushes especially at night, my doctor will not prescribe HRT I was on it till I was 55 as I had a hysterectomy at 44 this last year I have been so uncomfortable at night especially in bed I tried alternative medicine to no avail can you help?
alison sproule, port glasgow, inverclyde
i am a 46 yr old male reasant this year after 4 yrs blood tests was diagnosed april 07 with pressure on the forehead which since sept 07 was a small dose thyroxin and as of today now subscribe full dose this problem is on the pituary gland to my forehead i suffer with short term memory loss and affects my work also caused me high blood pressure does this affect most people
chris vernall, crewe, uk
HI I AM A 35 YEAR OLD FEMALE WITH AN OVERACTIVE THYROID. ABOUT 4 YEARS AGO I WAS GIVEN RADIO ACTIVE IODIENE WHICH HAS COMPLETELY MESSED MY THYROID UP. I AM CURRENTLY ON 400MG OF THYROXINE A DAY AND HAVE BEEN FOR ALMOST A YEAR. (YES YOU READ RIGHT 400MG A DAY) AND IT STILL ISN'T WORKING. i AM ALSO HAVING TO GO THROUGH IVF AS I HAVE SEVERE ENDOMETRIOSIS AND AM WORRIED ABOUT WHAT WILL OR WONT HAPPEN IF I MANAGE TO BECOME PREGNANT WITH THE IVF. Please can you help.
wendy halliday, aberdeen, scotland
penis dysmorphobia? not me then! I have a small penis, but I love it when compared to bigger ones by girls, size queens, oh we are all freaks when it comes to sex, internet to blame??? sexual fantasies are a persons most hidden secrets!
Adam Webb, MK, UK
I cannot understand how women, just because they had a good birth experience at home can criticise hospital births. Forty years ago I had a son in hospital and was made to deliver on my back with feet in stirrups! We were both fine but a friend of that period had a difficult birth at home. I felt glad I had mine in hospital. My second delivery was still in hospital but the birth was so easy it could have happened at home. When I became pregnant for the 3rd time I had to almost beg to go into hosital. Thanks goodness I needed a lot of help and care afterwards. My point being - we can never predict how well a delivery may be. Please ladies forget about how wonderful you want the experience to be and concentrate on a safe healthy baby and a "rest" afterwards.
fran of norwich, norwich, norfolk
Re: Aspirin and flying. Some experts suggest that, as aspirin acts mainly on the arterial system and blood clots form in the veins, aspirin has no part in the prevention of clots.
Vivian, Hvar Island, Croatia
...another argument implying that childbirth is a disaster waiting to happen and is only safe in retrospect.
Can someone in the media please do some research on the training of midwives (and the ongoing training once qualified)? It is mandatory that midwives train in neonatal resuscitation techniques every year, and are also trained to deal with most obstetric emergencies (be it at home, on the bus, in a yurt, or up a mountain). Midwives support and promote the normality of birth, but equally are also trained to recognize the parameters of normality so that when a deviation is seen, appropriate help is sought: and that includes transfer to hospital if attending a homebirth.
Planning for a home birth is not final and binding and not forced on women (despite what the media would have us think). Midwives offer 'informed choice': pros and cons (based on extensive research) are discussed and the woman makes up her own mind. Something the medics often fail to consider...
Hacked off student midwife, London,
With modern forensic, post-natal techniques paediatric neurologists can tell by acidosis in the cord blood precisely how minutes of oxygen deprivation a baby suffered during a delayed birth and how much additional brain-damage each successive minute caused. So, at least if something does go wrong during a home birth it should be possible to discover afterwards whether being 5 minutes away from emergency intervention or 15 would have made much of a difference. Not much comfort to the new mother of a disabled child of course, but it might reassure her that the home birth was not necessarily an enormous factor in her child's lifelong impairment as 5 minutes might have meant her child would someday walk and talk and 15 that they would do one or the other but not both. Imagine what it must be like for a healthy, full-term baby struggling to be born and to breathe with its cord failing but stuck helpless inside its mother. This is real life and its a life-sentence for parent and child.
Michelle, Chislehurst, UK
Hi as a midwife currently providing a homebirth service then the importance that should be placed on a womans instincts can not be underestimated. Midwifery practice is evidence based but also works "with woman" to ensure that where possible the pregnancy experience meets her wishes and expectations. In the case of homebirth I have looked after many women who "safely" deliver at home but conversely have transferred women into hospital due to them not feeling happy at home or complications arising (as can happen in hospital labour). It is unusual for complications to arise out of the blue and with watchful, competent midwives any problems can be pre-empted and acted on. It is also important as midwives that we listen to women as they are most aware of what is happening to their bodies. In this current climate it is important that womens choice is valued and supported where possible. For appropriately assessed women with straight forward pregnancies home birthshould always be an option.
Lucy , East Anglia,
With Dr Stuttaford’s response to Margaret in London, all is made clear: agree with him, and receive a pat on the back as a good girl. Disagree, and receive a reply that is patronising or verging on the rude reply. Little woman, know your place, and do as doctor tells you.
Incidentally, I was born in hospital in the mid-seventies to a mother of thirty, my younger sisters at home a few years later. Re. the long-term study Dr Stuttaford suggests, of the three of us only I have ever been hospitalised, and otherwise we are all healthy, intelligent, and and productive members of society. It's hardly a proper study, but it's just as good evidence as "I had to have a forceps delivery, thank goodness I was in hosptial", when hospitalized brith itself increases the likelihood in a low-risk birth of a forceps delivery.
Catherine, Oxford,
I suffered from severe joint pain and extremely painful feet for two years at the start of my menopause. I was referred to Arthritis Clinic which took around 9 months before being seen there (leaving me to suffer and deal with the side-effects of medication which did little if anything to help), until I read of an old remedy of two capfuls of cider vinegar added to cup of boiled hot water with two teaspoons of Manuka honey to taste. Take this twice to three times a day. Its not a cuppa you would want to take time over drinking, but a small cup of this taken as above over a period of three months, resulted in very little joint pain now and pain free feet for the first time in two years. The joy of walking now is something I never take for granted.
Try sea kelp supplements to help thicken hair.
Isovon (Soy Isoflavones) may be worth trying also.
I empathise with all you are experiencing but good luck.
Sylvia, Glasgow, Scotland
..I have been losing hair from fringe and temple area very slowly over last 2/3 years and deduct that it is probably male pattern baldness resulting from falling oestrogen levels.As I have an extremley high hairline anyway and have always used fringe to soften severe look it is very de
pressing to think that by the time my menopause is over I could lose a lot more(as Idid after birth of my 2 children).I'm 50,eat lots of fruit,veg,soya ,pulses and even red meat I have had negative tests for underactive thyroid ,anaemia and abnormal testosterone levels I.have taken all sorts of supplements to no avail and would willingly take H.R.T. if this slowed down hair loss.Is there really nothing I can do?My French GP won't even do a hormone test until I have been period free for at least 6 months,despite extreme fatigue,joint pain,bad temper and memory problems.
Thomas Julie, Le Mans, France