Health News

Yes, in the sense that we all lose bone from about the age of 35 or so. As men start with much bigger, stronger bones than women, they are much less likely to get it, and so are women who have big bones. You are most at risk of developing osteoporosis if:

• you had a menopause (surgical or natural) before about the age of 40 or 45

• you have a medical condition that requires you to take cortico-steroids in high doses for several years

• you have had a Colles5 fracture of the wrist after the menopause, following a comparatively minor fall

• you have suffered from anorexia nervosa or bulimia

• you had amenorrhoea (absence of periods) for several years during your normal reproductive years

Other factors which increase your chance of getting osteoporosis are if:

• you are white or Asian

• you are small-boned, light in weight, and slender in build

• your mother, grandmothers or aunts had it

• you finished the menopause 10 or more years ago

• throughout most of your life you have eaten a diet low in calcium

However, people who don’t fall into any of these categories can get osteoporosis.

These are mostly things you can’t do anything about. There are some things you can do something about which contribute to osteoporosis:

• smoking (which lowers the natural level of oestrogen, and brings on the menopause up to five years earlier than it would otherwise have started)

• drinking large quantities of alcohol (which reduces the absorption of calcium from the digestive system, and slows down the activity of bone-forming osteoblasts)

• taking little or no weight-bearing exercise (bones get stronger when they are well used, and weaken when they are seldom used)

• dieting so severely that your periods (and thus your oestrogen production) stop

• continuing to have a diet low in calcium.

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Each year hundreds of thousands of women worldwide have their uterus surgically removed, many find the experience a landmark event. Some feel very positively about it, others have mixed feelings, and some experience intense regret. Deciding whether or not to have a hysterectomy and which type is most suitable can be difficult, especially when the views of trusted advisers are in conflict. In the case of Lisa, aged forty-two, friends, relatives, her partner and doctor held strong but differing opinions about the merits and drawbacks of the procedure. Some were enthusiastic about it, others thought there were other options, such as endometrial resection, that Lisa should investigate before agreeing to the removal of her uterus. Still others were adamant that hysterectomy was only to be considered in the most exceptional circumstances which, they assured Lisa, hers were not. She felt confused, a feeling made worse by criticism from her doctor that she was talking to too many people.

The distress of women who, like Lisa, are in the invidious position of having to decide whether to have a hysterectomy or find other ways of resolving their problems is evident. Even women who have an intimate acquaintance with the anatomy of the female pelvis can find the situation daunting. For example, when Sydney gynaecologist Caroline de Costa was contemplating a hysterectomy in 1992, she was nagged by fears right up to her arrival in the operating theatre.

The story told by de Costa, one of the few gynaecologists in Australia ever to have had a hysterectomy, reflects the anguish and ambivalence of many women contemplating the procedure. One of her fears was that she would feel enormous regret for the loss of her uterus and for her inability to bear any further children. She told herself this was ridiculous — at forty-five years of age and with seven children spaced over twenty-four years, why not put an end to the increasingly long, heavy and painful periods she was experiencing more and more often? De Costa also had a prolapsed uterus, had postponed her decision for several years and felt it was irrational to delay having the operation any longer. Another lingering concern was how she would actually feel, within her abdomen and pelvis, once her uterus was removed. ‘Perhaps there was something my patients hadn’t told me,’ she thought. ‘Perhaps I will feel a kind of black hole between my bladder and bowel.’

The experience of contemplating a hysterectomy over a long time, then going ahead with it, brought home to de Costa the emotional turmoil that many women in the same situation go through. It resulted in a change in the way in which she conducted her consultations. ‘I am certainly spending more time now in discussion with patients in an attempt to allay these fears,’ she said after making a full recovery and returning to her practice.

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Addiction means an increased tolerance of the body to the drug; hence a higher and higher dose is required to achieve the same drug effect. The body also becomes physically dependent on the drug to function effectively. If the drug is withdrawn suddenly, the body craves it, and the person experiences a whole range of psychological and physical symptoms. With benzodiazepine about 20 withdrawal symptoms have been described. These include tension, sweating, agitation, muscle ache, and irritability, but the most important is ‘rebound insomnia’.

Insomnia is a subjective feeling and is influenced by many factors. The main component of insomnia is the distress felt as a result of not being able to sleep. People who say they are suffering from insomnia may in fact be getting enough sleep. But why do these people say they are not sleeping? It is because of the distress they feel when they are not able to fall asleep when they want to. These people who get enough sleep biologically and yet complain of insomnia.

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